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NHS Halton CCG & NHS Warrington CCG Joint Meeting of the Governing Body Agenda – 8th April 2020

NHS HALTON CCG AND NHS WARRINGTON CCG

JOINT MEETING OF THE GOVERNING BODY TO BE HELD ON WEDNESDAY 8TH APRIL 2020 AT 2.20 P.M. – 3.50 P.M.

VIRTUALLY VIA MICROSOFT TEAMS

AGENDA

Agenda Item No

Timings (approx.)

A 2:20 p.m. Apologies for Absence: Eileen O’Meara

All

B Declarations of Interest in Agenda Items A conflict of interest is defined as “a set of circumstances by which a reasonable person would consider that an individual’s ability to apply judgement or act, in the context of delivering, commissioning or assuring taxpayer funded health and care services is, or could be, impaired or influenced by another interest they hold”

All

C Chair's Remarks and Questions from the Public (members of the public have been asked to raise any questions in relation to today’s agenda in advance of the meeting)

Chair Verbal

D Minutes of the Joint HCCG and WCCG Governing Body Meeting held on 11th March 2020 (for approval)

E Matters Arising

F Clinical Chief Officer Report (to note and endorse)

Andrew Davies Enclosure

Quality & Patient Experience:

033/20 Chief Nurse Report (to receive assurance)

Michelle Creed Enclosure

Corporate Business & Governance:

034/20 Financial Report (including Corporate Performance Report)

• Financial and Operational Performance Overview – Month 11

• 2020/21 Financial Outlook (to note)

Bryan Webb Enclosure

NHS Halton CCG & NHS Warrington CCG Joint Meeting of the Governing Body Agenda – 8th April 2020

035/20 Any Other Business

All

036/20 Date and Time of Next Meeting: Wednesday 13th May 2020

Public Halton CCG and Warrington CCG Joint Governing Bodies Meeting

Wednesday, 11 March 2020 4.00pm to 5.30pm Large Conference Room, The Gateway, Sankey Street, Warrington WA1 1SR

Halton CCG Members in Attendance:

Name Position Organisation

Ruth Austen-Vincent Lay Member NHS Halton CCG

David Cooper Chief Finance Officer NHS Halton and NHS Warrington CCG

Dr David Wilson (present for Items A, B and 002/20 only)

GP Member - Federation Representative NHS Halton CCG

Gareth Hall Lay Member NHS Halton CCG & NHS Warrington CCG

Dr Claire Forde (present for Items A, B and 002/20 only)

General Practitioner Governing Body Member

NHS Halton CCG

Dr Julie Langton Secondary Care Doctor NHS Halton CCG & NHS Warrington CCG

Leigh Thompson Chief Commissioner NHS Halton CCG

Dr Andy Davies Chief Clinical Officer NHS Halton CCG and NHS Warrington CCG

Warrington CCG Members in Attendance:


Dr Ian Watson (IW) Chair NHS Warrington CCG

Gareth Hall Lay Member (Chair) NHS Halton CCG & NHS Warrington CCG

Dilys Quinlan Lay Member NHS Warrington CCG

David Cooper Chief Finance Officer NHS Halton and NHS Warrington CCG

Dr Julie Langton Secondary Care Doctor NHS Halton CCG & NHS Warrington CCG

Dr Andy Davies Chief Clinical Officer NHS Halton CCG and NHS Warrington CCG

Dr Lalit Sakhi (LS) General Practitioner Governing Body Member

NHS Warrington CCG

Dr Sangeetha Steevart (SS) General Practitioner Governing Body Member

NHS Warrington CCG

Dr Aparna Rao GP Governing Body Member NHS Warrington CCG

Dr Golam Chowdhury GP Governing Body Member NHS Warrington CCG

In Attendance:


Stacy Evans Head of Quality and Safety (deputising for Michelle Creed)

NHS Halton CCG

Suzanne Barker Chief of Corporate Services NHS Halton CCG and NHS Warrington CCG

Maria Austin Chief of Public Affairs and Engagement NHS Halton CCG and NHS Warrington CCG

Louise Murtagh Senior Committee Administrator NHS Halton CCG

Colin Scales (present for Items A, B and 002/20 only)

Chief Executive Bridgewater Community Healthcare NHS Foundation Trust.

Professor Simon Constable (present for Items A, B and 002/20 only)

Chief Executive Warrington and Halton Teaching Hospitals NHS Foundation Trust

Apologies:

Shahzad Tahir Lay Member NHS Halton CCG

David Merrill Interim Chair NHS Halton CCG

Kevin Goucher Governing Body Member NHS Warrington CCG

Nick Atkin Lay Member NHS Warrington CCG

Dr Latha Meda GP Member - Federation Representative Widnes Highfield Health Ltd

Michelle Creed Chief Nurse NHS Halton CCG and NHS Warrington CCG

Eileen O’Meara Director of Public Health Halton Borough Council

Kath Parker Healthwatch Chair Healthwatch Halton

Minutes:

A. Welcome and Introductions

Introductions were made and the Chair welcomed all present to the meeting. It was noted that the Warrington CCG Governing Body meeting was quorate. Halton CCG Governing Body was not quorate. Any decisions made by Halton CCG Governing Body members present would be recorded and an email would be sent following the meeting to those not present asking for their decision in respect of relevant agenda items. ACTION: Louise Murtagh to email Halton CCG Governing Body members following the meeting requesting a response to item 001/20 Outline Proposal for Mid Mersey Merger. Following Apologies and Declarations of Interest, report 002/20 was considered first followed by 001/20 and 003/20.

B. Apologies

Apologies were received from those listed above.

C. Declarations of Interest

The Chair reminded attendees of their obligation to declare any interest they may have on any issues arising at the meeting which might conflict with the business of the CCG. For the purposes of this meeting, a conflict of interest was defined as “a set of circumstances by which a reasonable person would consider that an individual’s ability to apply judgement or act, in the context of delivering, commissioning, or assuring taxpayer funded health and care services is, or could be, impaired or influenced by another interest they hold”. Declarations made by members of the Governing Body were listed in the respective CCGs’ Registers of Interests. The Registers were available on the CCGs’ websites. Dilys Quinlan highlighted that she was a Lay Member at NHS Wirral CCG and the Director of Healthwatch St Helens. Gareth Hall reported that he was a Lay Member at Health Education England and a

Board Member at MSV Housing.

001/20 Outline Proposal for Mid Mersey Merger

Members were reminded that Warrington CCG Governing Body was quorate and therefore could take a decision on the proposal. Votes would be recorded from Halton CCG Governing Body members however, the any decision would not be binding at this point. An email would be sent following the meeting to those not present asking for their decision. Dr Andy Davies presented a paper, prepared jointly with Professor Sarah O’Brien, Executive Director People Services/Clinical Accountable Officer, St Helens CCG. In this report, members were asked to provide approval to the Management Teams to explore the potential of merger to establish a single NHS strategic commissioner for the Mid-Mersey region. To start the process Governing Bodies were also asked to confirm the establishment of project support arrangements to oversee this work through the appointment of a Senior Responsible Officer (SRO) and required project infrastructure arrangements. Members discussed Halton specifically in that its population was split into two distinct areas of Runcorn and Widnes and considered the flows of patients in respect of hospital treatment. Discussions moved on to the proposed merger and how this would fit with providers in the area who were also considering merger options. Attendees agreed that exploring potential options and considerations would address a number of issues but that a very clear communications and engagement stakeholder plan was required to support all of this work. Warrington CCG Governing Body and Halton CCG Governing Body members present agreed the following:

• Approved that the Management Teams explored the potential of merger to establish a single NHS strategic commissioner for the Mid-Mersey region.

• Supported the establishment of project support arrangements to oversee this work through the appointment of a Senior Responsible Officer (SRO) and required project infrastructure arrangements.

• Noted the requirements to receive further information in respect of this matter at a Governing Body Meeting to be held in April 2020 (most likely to be held on 8th April 2020)

Approval by Shahzad Tahir, David Merrill, Dr Latha Meda, Michelle Creed and Eileen O’Meara would be sought in writing following the meeting.

002/20 Intention to Progress an Acquisition of Bridgewater Community Healthcare NHS Foundation Trust by Warrington & Halton Teaching Hospitals NHS Foundation Trust

Colin Scales (CS) and Professor Simon Constable (SC) attended the meeting to discuss the collaboration between Bridgewater Community Healthcare NHSFT and Warrington and Halton Teaching Hospitals NHSFT. Members were reminded that in August 2019, representatives attended a Joint Governing Body meeting to advise of partnership arrangements that were in place at the time. This presentation provided information on the progress of these discussion since August 2019.

SC set the context of working together with the primary driver being that both served the same populations across Halton and Warrington. These patients needed to be looked after in a more integrated way across community and hospital settings. The case for change had been presented to NHS England & Improvement and it had supported the Trusts to move to a more formal working relationship. This case highlighted the proposed benefits including improved quality services, greater opportunities for innovation and financial efficiencies. The wider context on how a formal collaboration satisfied the requirements of the NHS Long Term Plan were also referred to. CS moved on to talk about the primacy of place and the move towards an Integrated Care System. For ease of the ‘transaction’ the proposal made to NHS England & Improvement was for the acquisition of Bridgewater Community Healthcare NHSFT by Warrington and Halton Teaching Hospitals NHSFT. However, both were adamant that this was not a take-over of a community provider by an acute trust. Recent progress included:

• Joint working with PCNs. This was developing across both boroughs but Halton was further on than Warrington currently.

• Integration collaborative with adult and children’s social care, community and acute services. CS noted that there was a greater focus needed on children’s services.

• Clinical services reconfiguration n e.g. Long Term Conditions. This would provide a great opportunity to drive on improvements

• Planned contribution to system financial recovery. The ‘system’ was already working well to achieve this.

To assist with the acquisition the Trusts were using an NHS timeline template to help plan key milestones. Members were advised that these were not set in stone and could be altered to fit in with specific requirements for this transaction. Discussions moved on to consultation and engagement with stakeholders with the staff themselves being key to this process. CS and SC confirmed that discussions had been on-going for over 18 months. Comments received included the tie-in of the Engagement and Involvement Group at Halton and to avoid any events or deadlines over the Christmas period. Maria Austin confirmed that the Communications Plan had been shared with the CCGs and would come to the CCGs Quality Committees and to the Engagement and Involvement Group. Members commented that there was a need to develop two models as Halton and Warrington were very different boroughs. An example of this was that Halton did not have an acute hospital. The focus needed to remain as provision over the two places. Following discussion Governing Body Members noted the presentation.

003/20 Any Other Business

None to report.

AGENDA ITEM NO: F

1

GOVERNING BODY MEETING:

Joint Governing Body Meeting of NHS Halton CCG and NHS Warrington CCG

DATE OF MEETING:

8th April 2020

REPORT AUTHOR AND JOB TITLE:

Dr Andrew Davies, Clinical Chief Officer, NHS Halton CCG and NHS Warrington CCG

REPORT TITLE:

Clinical Chief Officer Report

STRATEGIC OBJECTIVES:

Please tick which strategic objectives the paper relates to

Improve quality of services

X

Sustained financial balance

Build an effective and motivated whole system workforce

X

Sound governance arrangements

X

Ensure integration and joint working arrangements

X

OUTCOME REQUIRED (tick)

Approval

Assurance

✓

Discussion

✓

Information

✓

EXECUTIVE SUMMARY

The purpose of the report is to provide members of the Governing Body with:

• An update on any key corporate issues that members need to be appraised and aware of

• An update on any key national and local issues relevant to the CCG

• A summary of key activities that support delivery of the CCGs strategic objectives (not referred to elsewhere in the Governing Body papers)

Please note this is a summary paper to provide relevant update and assurance to the Governing Body on key matters during the COVID-19 pandemic period.

AGENDA ITEM NO: F

2

RECOMMENDATIONS

The Governing Body is asked to:

• Note the contents of this report and support the handling arrangements in respect of COVID-19.

Outline any engagement – staff, clinical, stakeholder and patient / public

Not applicable

Are there any conflicts of interest which may be associated with this paper?

Not applicable

Does this paper address any existing risks which are included on the Assurance Framework or Risk Register?

Not applicable

Have the following areas been considered whilst producing this report?

Yes

N/A

Equality Impact Assessment (if yes, attach to paper)

✓

Quality Impact Assessment (if yes, attach to paper)

✓

Regulation, legal, governance and assurance implications (reference in the report if applicable)

✓

Procurement process (reference in the report if applicable)

✓

Document development

Has this document been presented to any other Committee or Forum? If yes, please list which meeting, date and outcome of presentation

Not Applicable

AGENDA ITEM NO: F

3

1. Purpose

The purpose of this report is to provide Members of the Governing Body with:

• information in respect of relevant local and national initiatives and priorities

• information on key issues that may have not been covered elsewhere in an individual report

Please note this is a summary paper to provide relevant update and assurance to the Governing Body on key matters during the COVID-19 pandemic period. This is in line with national guidance in respect of revised governance arrangements during the current period. Therefore, this report does not include the usual review of meetings attended or overview of recent national communications. 2. Updates for Governing Body

a) Update on Mid-Mersey Integrated Working

In March 2020, the Governing Body approved plans for the Integrated Management Team to explore potential options for CCG integrated working on a mid-Mersey footprint and also appoint a Senior Responsible Officer to lead the development of this work. However, with the absolute focus on supporting the NHS to tackle the COVID-19 pandemic, NHS England has decided to suspend CCG merger work programmes during Quarter one with a review at the end of this period. The newly appointed Senior Responsible Officer (Paul Sly) has with the agreement of the two Accountable Officers and NHS England significantly scaled back the planned work in April, May and June to ensure there is no impact on the COVID-19 response. Background work on developing the High Level Project Plan, Case for Change and the Communication and Engagement Plan will continue, and fortnightly touch points with the Accountable Officers have been scheduled to review progress. Communications (1-2-1 calls) with Governing Body members will be arranged with the SRO to help shape the next phase of integrated working between the three CCGs, and the development of the Case for Change. It is recognised however that calls with GP Governing Body members and other Governing Body clinicians will not be scheduled during the first phase of this work.

b) Chief Finance Officer Arrangements To support the robustness of our arrangements during the COVID-19 period, discussions have taken place in respect of resourcing requirements for the Incident Coordination Centre to ensure effective leadership, experience and resilience. As a result of these discussions, it has been agreed that David Cooper, Chief Finance Officer will be seconded to the ICC for a three month period (with regular reviews of requirements) with effect 1st April 2020. During this period, Bryan Webb, Deputy CFO will formally act up into the position of Chief Finance Officer for NHS Halton CCG and NHS Warrington CCG.

AGENDA ITEM NO: F

4

c) Response to Coronavirus (COVID-19) CCG Approach The CCG Incident Co-ordination Centre (ICC) was established on Monday 9th March 2020 to oversee and co-ordinate the response for NHS Halton CCG and NHS Warrington CCG. Led by the Clinical Chief Officer, the control room is supported by dedicated staff undertaking the roles of Incident Director, Incident Manager, Incident Administrator and Action Handler. The ICC is now operational 7 days a week with extended hours and with two Incident Control Room teams working a rotational shift system.

The ICC is supported by various members of the IMT taking a lead across sector issues including Primary Care, Acute, Community, Mental Health & Learning Disability and Care Homes. This is also supported by underpinning infrastructure workstreams in respect of Communications, Workforce (inc Health and Wellbeing), Finance, Quality & Safety and IT & Estate.

A daily call is in place with colleagues in Primary Care across Halton and Warrington to understand current issues and risks.

Robust command and control procedures have been established which enable the co-ordination of efforts from a health perspective to ensure that patients and core services are being protected. There are three levels within the command and control structure, from strategic/tactical, to system-wide and local internal incident management. System Working NHS Halton Clinical Commissioning Group (CCG), NHS Warrington Clinical Commissioning Group (CCG), Halton Borough Council and Warrington Borough Council are working closely with local NHS providers, Public Health England (PHE), NHS England and other partner organisations in order to co-ordinate our approach in dealing with the pandemic.

A strategic system response group has also been established with meetings taking place on a weekly basis. The membership of the group contains senior representatives from NHS Halton CCG, NHS Warrington CCG, Warrington Borough Council, Halton Borough Council, Public Health and our main NHS providers.

The purpose of this group is to support the coordination of the local health and social care response in the Halton and Warrington area, in the event of an epidemic or pandemic involving infectious disease, being declared.

Handling of Communications

A Halton and Warrington System Communications Group has been established with representatives from all health and social care organisation. This group is working collaboratively to co-ordinate and support all communication and media activity The group meets virtually every Monday and Friday. Local media outlets have been engaged and have responded positively in terms of supporting communications with the public. A dedicated COVID page has been established through the local media. All media and social media activity has been significantly increased to ensure consistent and timely public messages across all communities.

AGENDA ITEM NO: F

5

In line with supporting our new interim working arrangements in response to COVID-19, we have reviewed and implemented a number of internal processes to support internal communication and staff engagement, these include;

• Virtual staff brief via TEAMs – every Monday (3pm) and Friday (10am)

• Daily staff COVID brief

• Weekly Round-Up (single brief for staff, Governing Body members and external stakeholders)

Staffing We have established a number of workstreams to ensure we effectively manage workforce issues during this period and also support the health and well-being of our staff at this time. This includes work in respect:

• Supporting and equipping our staff to work from home effectively and also mechanisms to keep in touch and connected with each other

• Supporting staff with changes to childcare and caring responsibilities

• Identifying, supporting and making any required adaptations in respect of staff in higher risk groups

• Staff Skills Scans to support any potential re-deployment activities

• Strengthened reporting of absence and attendance to support our duty of care and national requirements to track staff absence

• Implementation of a range of staff communications mechanisms and initiatives both at team and CCG level

• Information for staff both verbally and on-line including opportunities for questions and provision of FAQs to address pertinent questions

• Implementation of a range of staff engagement and support mechanisms to ensure staff receive the necessary emotional and wellbeing support during this period. This is also supported by the continuing work of the Staff Engagement Group at this time to ensure staff remain connected, involved and supported.

Current Position In light of the changing position and priorities in respect of COVID-19, a detailed verbal update will be provided to Governing Body members at the meeting on the 8th April 2020 in respect of current issues and handling arrangements. Information and guidance: The latest from the UK Government can be found here: www.gov.uk/coronavirus Detailed NHS information is available at: www.nhs.uk/coronavirus

d) Reducing burden and releasing capacity to NHS Providers and commissioners to manage the COVID-19 Pandemic

The CCG has received further guidance from NHSE to direct and enable organisations to free up management capacity and resources to support and prioritise the COVD-19 response. This guidance is focussed on 3 key areas of activity:

• Governance and Meetings

• Reporting and Assurance

• HR and staff related activities

http://www.gov.uk/coronavirus

http://www.nhs.uk/coronavirus

AGENDA ITEM NO: F

6

IMT Leads have reviewed the respective areas and ensured current activities, arrangements and priorities are in line with this guidance. Particular areas to note for the Governing Body include:

• Streamlined requirements for GB Meetings in terms of key issues and meetings held virtually

• Streamlining or temporary cessation of other Committees

• Continued requirement in respect of Annual Accounts and Audit

• Anticipation that the Annual Report may be streamlined but waiting further guidance – draft due to be presented to Audit Committee on the 22nd April

• Review of decision making processes to allow for emergency decision making. Governing Body to consider the establishment of Urgent Issues Committee (to be discussed at the meeting on the 8th April 2020).

• Amendments and changes to requirements for monitoring of Constitutional Standards (some continuation of standards and others are temporarily suspended) – update to be provided as part of the Corporate Performance Report to Governing Body

• Amendments in respect of Quality and Safety reported as part of Chief Nurses report to Governing Body

• Suspension of CCG merger work programmes for 2020/21 during Quarter one with a review at the end of this period (as per brief above)

• CCG Governing Body GP to focus on Primary Care Provision

• Pause of Mandatory Training (unless essential in line with deployment) and Appraisals (unless exceptional circumstances) during this period.

e) Local Governance Arrangements and Actions

In light of the above guidance and previous correspondence, governance arrangements across both CCGs during this period are as follows:

• Governing Bodies to meet on a monthly basis in April, May and June 2020 (streamlined agenda in virtual meeting setting)

• Audit Committee to meet virtually in April and May (streamlined agenda in virtual meeting setting in line with the requirements of the Annual Report and Accounts)

• Remuneration Committee to be arranged virtually as required

• Primary Care Commissioning Committee, Quality Committee, Finance & Performance Committee and Performance & Finance Committee are all suspended on a temporary basis for three months (following reviews of work plans by Lead Officers – any urgent requirements for decision making will be handled as appropriate)

• The current composition of the two Governing Bodies remains in line with current constitutions and operating arrangements

• Extension to contracts of current GB Members to 30th June 2020 (as applicable) to ensure continuity and to minimise the requirements to engage with Primary Care and recruit into roles (particularly GP/Clinical Roles) at this time in light of COVID-19. This will be reviewed in early June 2020 and the usual engagement process will be enacted at an agreed future point

• Extension to contract of the Clinical Chair of NHS Warrington CCG Dr Ian Watson to 31st March 2020 in line with the outcomes of the Membership Ballot

AGENDA ITEM NO: F

7

• Dr Julie Langton, Secondary Care Doctor has agreed to extend her contract to 30th June 2020 to support the work of the two Governing Bodies and CCGs during this period

• Pause of the work in respect of the updates to the Constitution (reviewed by Governing Bodies in March 20) to enable finalisation of engagement with Member Practices, LMC and NHSE.

Following previous communications, the Governing Body of NHS Halton CCG is also asked to note that Shazhad Tahir, Lay Member left the Governing Body at the end of March 2020. We would like to extend our thanks to Shazhad for his commitment to the work of the Governing Body and NHS Halton CCG during his period of office. 3. Recommendations The Governing Body is asked to:

• Note the contents of this report and support the handling arrangements in respect of COVID-19.

Dr Andrew Davies Clinical Chief Officer 2nd April 2020

AGENDA ITEM NO: F

1



DATE OF MEETING:

8th April 2020


Suzanne Barker, Chief of Corporate Services

REPORT TITLE:

Urgent Issues Committee -Terms of Reference (for approve)







X



Approval

✓

Assurance

Discussion

✓

Information

EXECUTIVE SUMMARY

This document presents the draft terms of reference for the proposed Urgent

Issues Committee.

It is proposed, the Urgent Issues Committee (the Committee) is established as a

temporary committee arrangement to support any urgent decision making during

the current COVID–19 period. This predominately relates to matters previously

under the role and remit of the Quality Committee and Performance &

Finance/Finance & Performance Committee (committees currently suspended

during this period).

AGENDA ITEM NO: F

2

This proposal is in line with the national guidance in respect of “Reducing burden

and releasing capacity to NHS Providers and commissioners to manage the

COVID-19 Pandemic” where it is suggested that CCGs review decision making

processes to allow for emergency decision making.

A proposal to establish an Urgent Issues Committee as part of this response is referenced within the report of the Clinical Chief Officer to Governing Body on the 8th April 2020). Terms of Reference for an Urgent Issues Committee for NHS Halton CCG and NHS Warrington CCG are presented in this paper.

RECOMMENDATIONS

The Governing Body is asked to:

• Review and approve the draft terms of reference for the proposed Urgent Issues Committee.


Not applicable


Not applicable


Not applicable


Yes

N/A


✓


✓


✓


✓



Discussed and reviewed by the Integrated Management Team

1

URGENT ISSUES COMMITTEE Terms of Reference The Urgent Issues Committee (the Committee) is established as a temporary

committee arrangement to support any urgent decision making during the current

COVID–19 period. This predominately relates to matters previously under the role

and remit of the Quality Committee and Performance & Finance Committee

(Committees currently suspended).

Where decisions need to be taken as a matter of urgency, the Governing Body has

delegated authority to the Chief Clinical Officer to make decisions on behalf of the

CCG by convening an Urgent Issues Committee with membership as detailed

below.

The requirement for this Urgent Issues meeting to be held in private may be

determined by the Clinical Chief Officer by exception.

NHS Halton CCG and NHS Warrington CCG have each established their respective Urgent Issues Committees. However, the two CCGs have identified common areas and ways in which they will able to access joint knowledge and experience to support effective decision making. Accordingly, the CCGs have identified that there is merit in their respective Urgent Issues Committees meeting together as “Committees in Common”. Whilst each Committee will retain responsibility for its own functions and will remain accountable to its Governing Body, the CCGs believe that efficiencies may be achieved in establishing a “Committees in Common” approach, to share views and opinions on relevant issues and, where possible, to achieve consistency in decision making across the two CCGs. Each Urgent Issues Committee will have its own Terms of Reference (setting out the membership, remit & responsibilities and reporting arrangements), quorum and administrative arrangements. 1. Membership

• Chair of the Committee (Chief Clinical Officer or nominated deputy)

• Lay Member representative of the Quality Committee

• Lay Member representative of the Performance & Finance Committee

• Clinical Member of the Governing Body either GP Member or Secondary Care Doctor

• Chief Finance Officer (or nominated deputy)

• Chief Nurse (or nominated deputy)

• One other member of the Integrated Management Team

In attendance

• Chief of Corporate Services (or nominated deputy)

• Appropriate Representatives in line with Agenda items

• Committee Administrator

2

2. Quorum Four Members of the Committee including the Clinical Chief Officer or nominated deputy, a Lay Member, a clinician, Chief Finance Officer or Chief Nurse (or nominated Deputy). 3. Remit and responsibilities in Respect of Quality Committee The Committee shall meet to review any immediate and urgent concerns or issues in relation to service quality, safety, commissioning or provision and will provide the required assurance to the Governing Body on aspects of service quality within the CCG’s remit. This could include: 3.1 Clinical Effectiveness

• receive an update on any urgent quality issues for all providers of commissioned services

• review any urgent information, notification or advice received from NHS England, NHS Improvement, Quality Surveillance Groups, National Quality Board, CQC, or any external regulator which relates to or has a bearing on an NHS care provider’s provision

3.2 Safety

• prioritise and monitor urgent emerging actions to minimise risks across

Warrington and Halton CCG commissioned services

• receive and report on any Serious Incidents and/or reports or investigations of

Significant Events Analysis/audits

• receive and report on urgent issues in respect of infection, prevention and

control

• receive overviews and outcomes of any urgent independent investigation or

reviews carried out on any local providers and seek assurance that findings

and actions are in place to manage any issues identified

• seek assurance that there are appropriate arrangements in place in all

commissioned services in respect of Safeguarding as recommended by the

Quality Committee

• receive, review and advise on appropriate actions in relation to medicines

related incidents and medicines safety

3.3 Service User Experience

• consider any urgent service use feedback

4. Remit and responsibilities in Respect of the Performance & Finance

Committee The Committee shall meet to review any immediate concerns or issues in relation to

the:

• management of sudden financial pressures or risks.

3

• urgent decision of unplanned but essential immediate spend.

• immediate action in relation to possible financial mismanagement or probity

issue.

• any other aspects of the financial management of the CCG including risk

areas that requires urgent attention

5. Other urgent matters The Committee may also (in exceptional circumstances) review any immediate and urgent issues in relation to the following issues:

• matters in respect of Governance and Risk

• matters in respect of management risks

• matters in respect of Reputation and Communications

6. Administration The Committee will be supported by an appropriate administrator that will be responsible for supporting the Chair in the management of the Committees business. The administrator will take minutes and produce action logs as required. 7. Frequency and notice of meetings. The Urgent Issues Committee shall meet on an ad hoc basis as required in line with urgent business. IMT members may request a meeting of the Urgent Issues Committee to the Chair of the Committee if they consider one necessary in line with organisational requirements. 8. Reporting The ratified minutes of any Urgent Issues Committee will be submitted to the Governing Body (Public or Private dependent on the nature of Committee business). 9. Conduct All members are required to make open and honest declarations of the interest at the commencement of each meeting or to notify the Committee Chair of any actual, potential or perceived conflict in advance of the meeting. All members are required to uphold the Nolan Principles and all other relevant NHS Code of Conduct requirements. 10. Date and Review These Terms of Reference were reviewed by the Governing Body on 8th April 2020 Version No. [1] Review dates April 2021

1

URGENT ISSUES COMMITTEE Terms of Reference The Urgent Issues Committee (the Committee) is established as a temporary

committee arrangement to support any urgent decision making during the current

COVID–19 period. This predominately relates to matters previously under the role

and remit of the Quality Committee and Finance & Performance Committee

(Committees currently suspended).

Where decisions need to be taken as a matter of urgency, the Governing Body has

delegated authority to the Chief Clinical Officer to make decisions on behalf of the

CCG by convening an Urgent Issues Committee with membership as detailed

below.

The requirement for this Urgent Issues meeting to be held in private may be

determined by the Clinical Chief Officer by exception.

NHS Halton CCG and NHS Warrington CCG have each established their respective Urgent Issues Committees. However, the two CCGs have identified common areas and ways in which they will able to access joint knowledge and experience to support effective decision making. Accordingly, the CCGs have identified that there is merit in their respective Urgent Issues Committees meeting together as “Committees in Common”. Whilst each Committee will retain responsibility for its own functions and will remain accountable to its Governing Body, the CCGs believe that efficiencies may be achieved in establishing a “Committees in Common” approach, to share views and opinions on relevant issues and, where possible, to achieve consistency in decision making across the two CCGs. Each Urgent Issues Committee will have its own Terms of Reference (setting out the membership, remit & responsibilities and reporting arrangements), quorum and administrative arrangements. 1. Membership

• Chair of the Committee (Chief Clinical Officer or nominated deputy)

• Lay Member representative of the Quality Committee

• Lay Member representative of the Performance & Finance Committee

• Clinical Member of the Governing Body either GP Member or Secondary Care Doctor

• Chief Finance Officer (or nominated deputy)

• Chief Nurse (or nominated deputy)

• One other member of the Integrated Management Team

In attendance

• Chief of Corporate Services (or nominated deputy)

• Appropriate Representatives in line with Agenda items

• Committee Administrator

2

2. Quorum Four Members of the Committee including the Clinical Chief Officer or nominated deputy, a Lay Member, a clinician, Chief Finance Officer or Chief Nurse (or nominated Deputy). 3. Remit and responsibilities in Respect of Quality Committee The Committee shall meet to review any immediate and urgent concerns or issues in relation to service quality, safety, commissioning or provision and will provide the required assurance to the Governing Body on aspects of service quality within the CCG’s remit. This could include: 3.1 Clinical Effectiveness

• receive an update on any urgent quality issues for all providers of commissioned services

• review any urgent information, notification or advice received from NHS England, NHS Improvement, Quality Surveillance Groups, National Quality Board, CQC, or any external regulator which relates to or has a bearing on an NHS care provider’s provision

3.2 Safety

• prioritise and monitor urgent emerging actions to minimise risks across

Warrington and Halton CCG commissioned services

• receive and report on any Serious Incidents and/or reports or investigations of

Significant Events Analysis/audits

• receive and report on urgent issues in respect of infection, prevention and

control

• receive overviews and outcomes of any urgent independent investigation or

reviews carried out on any local providers and seek assurance that findings

and actions are in place to manage any issues identified

• seek assurance that there are appropriate arrangements in place in all

commissioned services in respect of Safeguarding as recommended by the

Quality Committee

• receive, review and advise on appropriate actions in relation to medicines

related incidents and medicines safety

3.3 Service User Experience

• consider any urgent service use feedback

4. Remit and responsibilities in Respect of the Performance & Finance

Committee The Committee shall meet to review any immediate concerns or issues in relation to

the:

3

• management of sudden financial pressures or risks.

• urgent decision of unplanned but essential immediate spend.

• immediate action in relation to possible financial mismanagement or probity

issue.

• any other aspects of the financial management of the CCG including risk

areas that requires urgent attention

5. Other urgent matters The Committee may also (in exceptional circumstances) review any immediate and urgent issues in relation to the following issues:

• matters in respect of Governance and Risk

• matters in respect of management risks

• matters in respect of Reputation and Communications

6. Administration The Committee will be supported by an appropriate administrator that will be responsible for supporting the Chair in the management of the Committees business. The administrator will take minutes and produce action logs as required. 7. Frequency and notice of meetings. The Urgent Issues Committee shall meet on an ad hoc basis as required in line with urgent business. IMT members may request a meeting of the Urgent Issues Committee to the Chair of the Committee if they consider one necessary in line with organisational requirements. 8. Reporting The ratified minutes of any Urgent Issues Committee will be submitted to the Governing Body (Public or Private dependent on the nature of Committee business). 9. Conduct All members are required to make open and honest declarations of the interest at the commencement of each meeting or to notify the Committee Chair of any actual, potential or perceived conflict in advance of the meeting. All members are required to uphold the Nolan Principles and all other relevant NHS Code of Conduct requirements. 10. Date and Review These Terms of Reference were reviewed by the Governing Body on 8th April 2020 Version No. [1] Review dates April 2021

AGENDA ITEM NO: 033/20

Chief Nurse Report NHS Halton CCG and NHS Warrington CCG Joint Governing Body Meeting 8th April 2020



DATE OF MEETING:

8th April 2020


Michelle Creed, Chief Nurse

REPORT TITLE:

Chief Nurse Report




X



X


X


X


Approval

Assurance

✓

Discussion

Information

EXECUTIVE SUMMARY

The purpose of the paper is to provide assurance from the Chief Nurse to the Governing Body with regard to the quality, safety and patient experience in services commissioned by NHS Halton CCG and NHS Warrington CCG.

RECOMMENDATIONS

The Governing Body is asked to receive this report by way of assurance regarding the Quality, Safety and Experience of Commissioned Services during the Covid-19 pandemic period.




As detailed within the report


None


Yes


Yes

N/A


✓


✓


✓


✓



Not Applicable



1 PURPOSE The purpose of the paper is to provide assurance from the Chief Nurse to the Governing Body with regard to the quality, safety and patient experience in services commissioned by NHS Halton CCG and NHS Warrington CCG.

2 QUALITY, SAFETY AND EXPERIENCE

2.1 NEVER EVENTS AND SERIOUS INCIDENTS

At the time of writing this report there has been 1 Never Event in St Helens & Knowsley Hospital Trust in relation to a retained swab related to a Gynae operation in Halton CCG commissioned services.

2.2 SAFEGUARDING

On 24th February 2020 Halton Borough Council were notified of an ‘Inspection of Local Authority Children’s Services’ or ILACS. The inspection is now finished and there is a period of factual accuracy checks and they will then receive the final judgement. During Covid-19 the Chief Nurse has established weekly teleconference calls with the strategic partners in Halton and Warrington, those being CCG, Local Authority and Police to collate intelligence and identify any emerging themes and trends. Areas of concern identified to date:

• Children in Care

• Vulnerable children

• Domestic Abuse

2.3 CARE HOMES – Covid 19 support

• Warrington have established Care Home System call twice weekly with all are Care Homes, CCG, LA on Tues and Thursday. Daily email updates to be sent to all homes with any key information or new guidance. All homes to email in/phone with any additional issues that occur in between the twice weekly calls

• Halton homes – to phone in to the LA if there are any issues, daily email updates to be sent to all homes with any key information or new guidance. We are exploring teleconference calls in addition. All homes to email in/phone with any additional issues that occur in between the twice weekly calls

• Chief Nurse having weekly teleconference calls with CQC and LA.

• Several support initiatives are in place:

o Establishing a Tracker to monitor all Care Homes re Covid-19

o Weekly reports to Primary Care have now moved to daily.

o Supporting the use of video conferencing for primary care, either establishing current use or supporting the purchase of laptops/ipads.

o Establishing equipment needs (thermometers, BP machines, pulse oximeters)

• Checking Business Continuity Plans



• Ensuring the receipt and use of the correct Personal Protective Equipment (PPE)

• Establishing the use of the bed capacity tracker in al care homes across Halton and Warrington and Halton Haven and St Rocco’s Hospice.

2.4 INFECTION PREVENTION AND CONTROL (IPC)

The IPC team are experiencing high level of demand, both for interpretation of guidance issues and advice and guidance to the system. The team have moved to 7 day working and 2 members of the Quality Team have been redeployed to support the non-clinical issues of tracking and system communication.

3 REDUCING THE BURDEN AND RELEASING CAPACITY AT NHS

PROVIDERS AND COMISSIONERS TO MANAGE THE COVID-19 PANDEMIC During this challenging period NHS England and NHS Improvement (NHSE/I) are committed to supporting providers and commissioners in allowing them to free up as much capacity as possible and prioritise their workload to be focused on doing what is necessary to manage the response to the COVID-19 pandemic. A letter of guidance was issued on 28th March 2020 to support this. The elements relevant to the Quality & Safety agenda are as follows:

3.1 Quality Accounts

The deadline for quality accounts preparation of 30 June is specified in Regulations. NHSE/I have deferred this. However, the presentation of the accounts to system partners has been suspended for the 2019/20 Quality Accounts.

3.2 CQUIN Whilst the CQUIN guidance around Q1 2020/21 is very clear, there is ambiguity about Q4 2019/20 payments. Providers do not have to submit their evidence of compliance with CQUINs until 30th April 2020 and would usually gather this during April. However, there are to be no further uploads to the national CQUIN data collection template during the Covid-19 period. There are a number of indicators where the entire CQUIN or a considerable proportion is in Q4 so to use Q1-3 and estimate up from here would disadvantage the providers. Furthermore, the quality elements may have significantly improved but the provider will not be able to evidence in the data collection. A decision to pay all providers has been made. The quality of service will be monitored and be included in the recovery plan surveillance for quality and safety.

3.3 Quality Committee

Provider Trusts and CCGs are asked to review the committee structure and streamline all committees. However, Provider Trusts have been asked to continue with the Quality Committee.

3.4 Friends and Family test Is suspended



3.5 Continuing Healthcare CHC assessments have been suspended. Capacity tracker, currently mandated for care homes, is now also mandated for hospices and intermediate care facilities. NHS will pay for all hospital discharge care during Covid-19 period

3.6 Clinical Audit

All national clinical audit, confidential enquiries and national joint registry data collection, including for national VTE risk assessment, can be suspended. Analysis and preparation of current reports can continue at the discretion of the audit provider, where it does not impact front line clinical capacity. Data collection for the child death database and MBRRACE-UK-perinatal surveillance data will continue as this is important in understanding the impact of COVID-19.

3.7 Appraisal and Revalidation

Recommendation that appraisals are suspended from the 28th March 2020, unless there are exceptional circumstances agreed by both the appraisee and appraiser. This should immediately increase capacity in our workforce by allowing appraisers to return to clinical practice. The GMC has now deferred revalidation for all doctors who are due to be revalidated by September 2020. NHSE/I requested that all non-urgent or non-essential professional standards activity be suspended until further notice including medical appraisal and continuous professional development (CPD) The Nursing and Midwifery Council (NMC) is to initially extend the revalidation period for current registered nurses and midwives by an additional three months and is seeking further flexibility from the UK Government for the future.

3.8 CCG Clinical Staff

A review of internal need has been undertaken in order to retain a skeleton staff for critical needs and the remainder of the staff have been redeployed to support

• Primary Care

• Care Homes

• Infection Control

• Serious Incident Management/Never Events

• Safeguarding

• Community Services. CCG Governing Body GPs to focus on primary care provision

4 PROVIDER QUALITY SURVEILLANCE

Agreement reached at C&M Quality Surveillance Group was to move to:

• Light touch quality surveillance for providers with Outstanding or Good CQC ratings and establish an escalation process for concerns.

• Continue with video conference CPQG for Providers in Requires Improvement or Inadequate. For NHS Halton and Warrington CCG, the focus remains on:

o Bridgewater CHFT o Halton Haven Hospice o Care Homes



5 CONCLUSION

The governing body should be assured that the system surveillance process is in place to identify best practise and sport early warning signs of system failure. However, this system and process will need to be reviewed in light of changing organisational forms, the financial recovery climate and engagement and involvement public requirements. This report has focused on business critical quality and safety oversight during Covid-19 period.

The Chief Nurse will submit a monthly report to the Governing Body for consideration and challenge during this current period.


Financial & Operational Performance Overview – Month 11 NHS Halton CCG and NHS Warrington CCG Joint Governing Body Meeting 8th April 2020



DATE OF MEETING:

8th April 2020


Bryan Webb, Acting Chief Finance Officer

REPORT TITLE:

Financial and Operational Performance Overview – Month 11





X



X



Approval

✓

Assurance

✓

Discussion

Information

EXECUTIVE SUMMARY

The purpose of this paper is to:

i. Provide an overview of the financial performance of both CCGs at period 11 of the 2019/20 financial year and the corresponding financial outturn projections;

ii. Advise on the going concern status for each CCG to inform the content of the financial statements for 2019/20; and

iii. Provide an overview of operational performance against national standards for periods to date during 2019/20.



RECOMMENDATIONS

The Joint Governing Body is asked to:

• Note the Financial positions for each respective CCG at month 11; and • Note the Financial Outturn projections for each CCG; • Note the financial risks that could impact on these outturn projections; • Approve the recommended “going concern” status for each CCG; and • Note the operational performance for the locality for period to date in 2019/20.


Not Applicable


Not Applicable


NHS Halton CCG: BAF 36, 43, & 41 NHS Warrington CCG: B1 to B5


Yes

N/A


✓


✓


✓


✓



Not Applicable



Purpose

1. The purpose of this paper is to update the Joint Governing Body on the financial positions of NHS Halton CCG and NHS Warrington CCG at period 11 (February 2020), and the financial outturn projections for, the 2019/20 financial year.

2. An overview of the operational performance for the Warrington & Halton locality is also included.

Month 11 Financial Position – NHS Halton CCG

3. The financial position at month 11 is a deficit position of £6.8m against the planned expenditure budgets. All available reserves have been utilised to support non delivery of QIPP for periods to date. The CCG forecasts an outturn position against planned expenditure budgets of £7.3m deficit position, which against the CSF resource unsecured (£1.3m) during this financial year culminates in a reported deficit of £8.6m within the financial statements. The CCG has been tasked with improving this reported position to support collective reporting across the Cheshire and Merseyside Health & Care Partnership, however this is deemed less and less feasible with the controls introduced as part of the COVID-19 response, with the agreement of contractual financial settlements encouraged with providers to reduce administrative burden and provide financial stability during this period. CCGs have been asked to assume no slowdown in Elective PbR activity as a consequence of the provider responses to COVID-19. These arrangements place risk against the existing CCG assumptions included within the month 11 forecast outturn, which will need to be managed through the completion of the accounts.

4. Non delivery against the outlined level of efficiency (QIPP) required to support the financial plan is a key contributor to the reported position both year-to-date and within the forecast outturn for the CCG. The projected delivery, against a planned requirement of £9.7m, is £2.6m.

5. A detailed account of the financial performance is included within Appendix 1.

Month 11 Financial Position – NHS Warrington CCG

6. The financial position at month 11 is an adverse position to planned expenditure of £14.6m. The CCGs projected outturn for 2019/20 remains at £16.1m. Other elements are consistent with prior period reporting. National instructions aligned to the COVID19 response for contractual management may impact on some the assumptions for local provider contract positions, with agreeing early financial settlements encouraged to reduce administrative burden and provide financial stability during this period, and this may present an element of risk during the completion of the 2019/20 accounts. This risk this is expected to be managed in line with the forecast outturn position communicated to the regulators during period 11.

7. Non delivery against the outlined level of efficiency (QIPP) required to support the financial plan is a key contributor to the reported position both year-to-date and within the forecast outturn for the CCG. The projected delivery, against a planned requirement of £16.4m, is £5.4m.



8. A detailed account of the financial performance is included within Appendix 2.

Going Concern Status – NHS Halton CCG and NHS Warrington CCG

9. The financial projections for both CCGs indicate reported deficits for the 2019/20 financial year. As part of the annual reporting cycle, the Governing Body is required to consider the going concern status of each respective organisation.

10. The basis of assessment for both CCGs has been outlined as per the following and this is recommended for inclusion with the reported financial statements:

The CCG’s financial accounts are prepared under a direction issued under the National Health Service Act 2006 (as amended). In the light of the 2019/20 deficit and the requirement to refer to the Secretary of State under Section 30 of the Local Audit and Accountability Act, the CCG has undertaken an assessment of its status as a going concern. The CCG has produced, alongside system partners, a long term financial plan that considers how the system will work collaboratively to manage the collective position into sustainable financial balance. These financial plans have been shared with NHS Northwest. For non-trading entities in the public sector, the anticipated continuation of the provision of a service in the future, as evidenced by inclusion of financial provision for that service in published documents, is normally sufficient evidence of going concern. Therefore, based on the above, the accounts will be prepared on a going concern basis recognising that:

i. Health care services will continue to be provided for residents of Halton/Warrington ii. The system has produced a longer-term financial plan which has been received by

NHS Northwest and the Cheshire and Merseyside Health & Care Partnership. iii. The CCGs have been notified of their financial allocations for the period of 2020-21

until the Financial year 2023-24.

Month 11 Operational Performance – Warrington & Halton locality

11. The March report, included as Appendix 3, details performance for January 2020 and February 2020 periods highlighting the following elements:

Urgent Care

12. Urgent care services are under severe pressure with all but one activity plans being exceeded for both NHS Warrington CCG and NHS Halton CCG. Most of the related performance standards are also not being met.

13. Notable performance improvement has been reported in relation to ambulance response times during recent periods, however the national standards are still not being achieved.



Planned Care 14. Warrington & Halton Teaching Hospitals NHS Foundation Trust is consistently performing well

against the national standards, outperforming the national average. However, capacity issues at multiple Merseyside based Trusts is impacting upon planned activity for both Halton and Warrington residents. These capacity issues have been addressed in the interim, however the backlog of patients remains an outstanding issue. Cancer

15. The Cancer standards are being achieved for periods to date with regards to Warrington & Halton Teaching Hospitals NHS Foundation Trust, however previous breast and dermatology capacity issues at St Helens & Knowsley Teaching Hospitals Trust have resulted in NHS Halton CCG failing both two week wait standards during this period. Mental Health

16. Performance against the Dementia standards remains strong for both CCGs. However, performance against IAPT standards is below the national standard and below that achieved last year for both CCGs.

Appendices

17. This report is supported by the following appendices:

• Appendix 1 - NHS Halton CCG Financial Position Period Ending 29th February 2020

• Appendix 2 – NHS Warrington CCG Financial Reporting 2019/20

• Appendix 3 – Joint Corporate Performance Report March 2020

Recommendations

18. The Joint Governing Body is asked to:

• Note the financial positions for each respective CCG at month 11; and

• Note the financial outturn projections for each CCG;

• Note the financial risks that could impact on these outturn projections;

• Approve the recommended “going concern” status for each CCG; and

• Note the operational performance for the locality for period to date in 2019/20.

NHS Halton CCG Financial PositionFinancial Monitoring Statements

Period Ending 29th February 2020 (Month 11)

Bryan WebbActing Chief Finance Officer

1 • Executive Summary

2 • Financial Plan Run Rate (Incl. CSF)

3 • Financial Outturn Scenarios

4 • Summary of Financial Position (Year to date & forecast)

5 • Sector Highlights

6 • Acute Trust performance

7 • QIPP Savings

8 • CCG Risks

9 • Conclusion

Contents

1. Executive Summary

The financial position at month 11 is a deficit position of £6.782m against the planned expenditure budgets. This is attributable to elementspreviously reported as risks now crystallising in the financial position, including acute based performance; non delivery of planned efficiencies(QIPP); and the financial consequences of the abandoned Urgent Treatment Centre procurement. All available reserves have been utilised tosupport non delivery of QIPP for periods to date. This position has been reported to NHS England and NHS Improvement through the SystemRecovery Plan and a revised forecast outturn trajectory has been reflected at Month 11 to reflect a planned year-end deficit of £7.3m.

Material financial impacts (greater than £0.250m) reflected in the outturn position in 2019/20 are as follows:

QIPP Savings: The latest forecast QIPP delivery is £2.5m against a target of £9.7m.

Acute Sector: The Warrington & Halton Hospitals NHS Teaching Foundation Trust Sustainability Contract performance is forecast to be aboveplan by £1.05m based on month 10 data, which is applied against the thresholds within the contract. The St Helens & Knowsley TeachingHospitals NHS Trust contract has an adverse position within month 10 data, which is largely attributable to the blended paymentarrangement for Non Elective care. The Royal Liverpool and Broadgreen University Hospitals NHS Trust contract has presented a more stableposition when compared to the month 9 reported position. All other contracts are cumulatively performing in line with planned levels. Nondelivery of planned QIPP against this sector continues to be the material financial risk against the delivery of the financial plan. Theabandoned Urgent Treatment Centre procurement has resulted in further non delivery of planned QIPP aligned to this with a corresponding£1.2m detrimental impact.

Mental Health : Inflation rates have been set by the council in respect of out of area mental health services, this has led to a pressure of circa£0.5m to the forecast outturn. Work has also been undertaken across the Mersey footprint to review rehab and ABI beds which has caused apressure for NHS Halton CCG during 2019/20.

Prescribing: Non delivery of planned levels of QIPP, impact of Category M price increases, NCSO impact and assumptions regardingPregabalin rebate are reflected within the outturn position.

Financial Position Overall Risk Rating : Red

2. Financial Plan Run rate (incl. CSF)

Overall Risk Rating : Red

• Cumulative Planned Deficit Profile

3. Financial Outturn ScenariosOverall

Risk Rating :

Red

• Financial Outturn Scenarios at month 11

-167-333

-500-667

-834-1,000

-1,167-1,335

-1,502-1,669

-1,836-2,000

-167 -333

-500 -467 -633

-800 -466

-633 -800

-366 -534

-

-6,782

-7,300

-5,216

-6,720

-7,382

-8,600

-10,000

-9,000

-8,000

-7,000

-6,000

-5,000

-4,000

-3,000

-2,000

-1,000

0

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

£'00

0

NHS Halton CCG 2019/20 Financial Outturn Scenarios

Plan Cumulative Defict Plan Revised Cumulative Deficit with CSF

Plan Net Risk Trajectory Reported Position

Risk Adjusted Financial Poistion Risk Adjusted Financial Poistion (incl loss of CSF)

Plan Net Risk Trajectory following CSF achieved

Q1&Q2 CSF £700k Q1-Q3 CSF £1,300k

Q1-Q4CSF £2,000k

4. Summary of Financial Position

• Financial Position

At month 11 the CCG reported a deficit position of £6.78m for periods to date against a planned deficit of £1.13m. Non Deliveryof QIPP is impacting on the planned position for the CCG with an adverse variance of £5.3m for periods to date, a detailedbreakdown of this is reported separately within section 7 “QIPP Position”.

• Key Highlights

Areas of Financial Deterioration

Acute Sector Performance £5.4m: QIPP Non Delivery £2.6m

WHHFT £1.1m YTD adverse positionSTHKT £0.6m YTD adverse (NEL Blended)

Mental Health £1.2m:High Cost packages of care / placements

Impact of new ABI contract arrangements

Prescribing £0.9m:Revised forecast expenditure to capture

Category M price concession impact, continued NCSO, and QIPP non delivery.


Plan Actual Variance Variance

£m £m £m %

Acute Services (ISFE) 112.82 118.22 (5.40) -4.8%

Mental Health Services (ISFE) 20.01 21.23 (1.22) -6.1%

Community Health Services (ISFE) 17.06 17.08 (0.02) -0.1%

Continuing Care Services (ISFE) 9.94 10.00 (0.06) -0.6%

Primary Care Services (ISFE) 5.25 4.89 0.36 6.8%

Prescribing 21.14 22.40 (1.26) -6.0%

Primary Care Co-Commissioning (ISFE) 17.36 17.36 0.00 0.0%

Other Programme Services (ISFE) 11.38 10.59 0.79 6.9%

TOTAL COMMISSIONING SERVICES 214.95 221.76 (6.82) -3.2%

Running Costs (ISFE) 2.75 2.72 0.03 0.0%

TOTAL CCG NET EXPENDITURE 217.69 224.48 (6.78) -3.1%

IN YEAR UNDERSPEND / (DEFICIT) (1.13) (7.92) (6.78) -3.1%

CCG EXPENDITURE ANALYSIS

Year to Date Net Expenditure

5. Sector Highlights

Acute

• Highlights: There is a an adverse variance of £5.4m across the Acute sector at month 11. This includes £2.6m ofQIPP non delivery against planned levels, the remaining balance relates to over performance on local acutecontracts including Warrington & Halton Hospitals NHS Teaching FT and St Helens & Knowsley Hospitals TeachingTrust. The short stay admissions audit has reached a conclusion and the CCG has profiled £0.521m of the adverseimpact into the position in this period. This adverse position to plan has been offset by savings delivered througha review of discretionary budgets in the same period.

• Key Impacts: Adverse variances to planned levels / cost of activity, particularly at St Helens & Knowsley HospitalsTeaching Trust, with the impact of the blended tariff arrangements for urgent care. Under delivery of QIPPschemes. UCC procurement abandonment has contributed to adverse performance against contract plans.

Mental Health

• Highlights: Pooled budgets including Section 117 have been set based upon last years budget plus inflation,pooled budget contributions are agreed. In 2019/20 rehab (incl. Acquired Brian Injury (ABI)) activity is paid forsolely based on usage. NHS Halton CCG has commissioned additional capacity and seen an increase in utilisationwhich is causing a cost pressure.

• Key Impacts: Inflation rates on out of area Mental health placements higher than anticipated, and activity inrespect of rehab and acquired brain injury beds (ABI).

Primary care

• Highlights: The CCG is reporting a year to date adverse position to plan of £0.901m, with a projected outturnadverse variance of £0.978m due to increase Cat M costs, NCSO and profiling of QIPP schemes on prescribing.

Continuing Care

•Highlights: Currently reporting an over performance of £0.064m which is net of the pool budgets overperformance against savings with CHC assessment support team (staff vacancies) and lower than expectedchildren's CHC activity. The latest financial forecast from Council has identified increased costs in CHC, work is on-going to verify the data provided.

•Key Impacts: Inflation on CHC higher than budgeted and additional packages of care in year higher thananticipated.

Community

•Highlights: Slight over performance of £0.018m due to an overspend on Hospices as a result of a long staypatient.

Other

•Highlights: Slight under performance against plan due to delayed recruitment of clinical leads and staff vacancieswithin the safeguarding team.

Running Costs

•Highlights: Running costs is currently on plan but there is still an outstanding credit budget of £0.131m withinreserves which is anticipated to be cleared by the end of the financial year.

5. Sector Highlights

6. Acute Trust Performance

The collective reported financial position for acute contracts at month 11 is an adverse variance to plan of £5.4m.This performance is determined based on 10 months worth of data. These figures now include a profiled impact of the prior yearactivity challenges and non delivery of planned QIPP. The month 11 position has profiled unidentified QIPP into the position. TheQIPP profiled during quarter 4 is not anticipated to be delivered and therefore is factored into the outturn projections for theCCG.

Key Highlights

Plan Actual Variance Variance

£000's £000's £000's %

Warrington & Halton FT 46,473 47,609 (1,135) -2%

St Helens and Knowsley Trust 44,440 45,071 (631) -1%

Royal Liverpool & Broadgreen and Aintree Trust 5,691 5,748 (57) -1%

Royal Liverpool & Broadgreen Trust 2,235 3,697 (1,462) -65%

Countess of Chester FT 1,390 1,347 44 3%

Liverpool Womens FT 1,239 1,186 53 4%

Aintree Hospitals FT 3,456 2,051 1,405 41%

Alder Hey 1,329 1,470 (141) -11%

Wirral 218 218 (1) 0%

WWL 285 271 13 5%

LHCH 696 874 (178) -26%

Other Acute Trusts (inc AQP) 4,879 5,186 (307) -6%

Non NHS Acutes 2,168 2,843 (675) -31%

QIPP Achievement (2,660) (24) (2,635) 99%

Other Acutes 1,351 1,086 264 20%

Ambulance 5,327 5,341 (14) 0%

TOTAL COMMISSIONING SERVICES 112,825 118,225 (5,400) -5%

Expenditure analysis

Year to Date Net Expenditure

7. QIPP Position

• QIPP Position

Acute sector QIPP achievement is based on activity available up to month 9 projected up to month 11.Overall QIPP savings reported at month 11 are £2.531m which is resulting in an adverse variance of £5.307m against theplanned level of QIPP of £7.838m. A £7.121m adverse position is the forecast against all schemes. Acute contract activity isbelow planned levels in recent periods, which could have a positive impact on QIPP position going forward. Non electiveactivity is under-performing against planned levels with blended payment impacting on this under performance. A number ofthe Acute Sector schemes were due to impact during the latter half of the financial year but due to this not materialising thishas been reflected within the forecast outturn.

Key Highlights


£m £m £m % £m £m £m %

UTC procurement 0.514 0.033 (0.481) 6% 0.610 0.033 (0.577) 5%

CHC fully funded 0.466 0.465 (0.001) 100% 0.508 0.507 (0.001) 100%

Prescribing savings 2.559 1.383 (1.177) 54% 2.804 1.383 (1.421) 49%

Acute Trust savings 2.593 0.189 (2.405) 7% 2.830 0.189 (2.642) 7%

Running Costs 0.125 0.121 (0.003) 97% 0.136 0.133 (0.003) 98%

High Intensity users (A&E avoidance) 0.011 0.007 (0.004) 64% 0.014 0.009 (0.005) 64%

Short stay at STHK 0.511 0.153 (0.358) 30% 0.557 0.153 (0.404) 27%

Unidentified Programme 1.059 0.181 (0.879) 17% 2.118 0.181 (1.938) 9%

Unidentified Running Costs - - - 0.131 - (0.131) 0%

7.838 2.531 (5.307) 32% 9.708 2.586 (7.121) 27%

CCG EFFICIENCY PLANS

Year to Date Forecast

Plan Actual Variance%

AchievedPlan Actual Variance

%

Achieved

8. CCG Risks

• Risks


(0.80)

(0.60)

(0.40)

(0.20)

-

0.20

0.40

0.60

0.80

£m

Risks Mitigations Net Risk (Unmitigated Risk)

Risks are limited at month 11 considering the majority of risks are now factored into the position. The CCG is still reporting £1.3mas a risk which is a combination of acute over performance alongside potential pooled budget overspends, these are over andabove what is factored into the forecast outturn position. The CCG expects this risk to be fully mitigated therefore no impact isanticipated within the overall outturn position reported.

9. Conclusion

The development of financial plans, across the North West footprint, for the 2019/20 financial year to meet both theexpectations outlined within planning guidance and to secure the designated control totals proved a collectivechallenge. There was also the emphasis on commissioners supporting providers to access all of the availablesustainability resources (FRF/PSF/MRET) to optimise the system position.

For NHS Halton CCG, this resulted in a financial plan being submitted with outlined risks of £5.6m against thedelivery of the control total of £2.0m planned deficit. The largest proportion of the risk outlined at the planningstage was in relation to the level of QIPP that had been included (£9.8m, or 8.4% of amenable budgets) with asignificant level unidentified at the planning stage. In consideration against that target, the Sustainability Contractarrangement has partially prohibited the application of cashable savings with Warrington & Halton Hospitals NHSTeaching Foundation Trust where the arrangements do not also reduce the cost of provision (i.e. win-win scenarios).

Most system based opportunities are aligned to pathway redesign (RightCare / GIRFT / Model Hospital) and thesystems’ agreed priorities have recently been outlined as Frailty; Coronary Heart Disease; Chronic Pain; and LiverDisease. These prioritised schemes are not anticipated to deliver cashable savings to the commissioner(s) within thefirst year of the programme.


• Note the financial position at the end of February 2020; and• Acknowledge the forecast outturn position that was submitted at Month 11;• Acknowledge the contributing factors within position, in particular the non delivery of QIPP savings; and• Note the application of the NHS Northwest protocol for deviations from assigned control totals during the

month 11 reporting period.

Financial Reporting

2019/20

April 2020

Contents

1 • Executive Summary

2 • Financial Position

3 • Financial Outturn Trajectories

4 • QIPP Position

5 • Risks and Mitigations

6 • Conclusion

1. Executive Summary

The financial position at month 11 (February) is an adverse variance to planned expenditure of £14.642m. A breakdown of thisexpenditure can be found in Appendix 1. The CCGs forecast outturn position for 2019/20 remains at £16.1m. The CCGs unidentifiedQIPP budgets continue to be the main internal contributor to the adverse performance against the planned position to date and theforecast outturn for the 2019/20 financial year. The CCG shall continue to work with System Partners to manage the collectivefinancial position to minimise the time to achieve system financial recovery.

Material financial performance issues are identified as:

• Acute Sector: Activity risk reserves have been fully utilised however with agreed collaborative sustainability adjustments theposition has shifted to an adverse variance of £3.982m year to date. The adjustments will help alleviate the financial pressureswithin the System. Independent Sector providers continue to cause a cost pressure, with £0.435m adverse variance year todate. Non Contracted Activity is creating an adverse variance to month 11 of £0.731m, largely attributable to NHS trusts in theNorth West of England and North Wales.

• Community: A year to date adverse variance of £1.766m due to the agreed collaborative sustainability adjustment.

• Primary Care (including Prescribing): PMD prescribing expenditure was lower than anticipated in December 2019. In yearallocations for Flash Glucose, recharges to NHS England for Flu, prescribing rebates, and February typically being a low valuemonth for prescribing have all helped improve the position year to date for prescribing to a favourable variance of £0.083m.Other includes spend such as Programme Projects (£0.290m adverse variance), Local Enhanced Services (£0.084m adversevariance) and Clinical Leads (£0.030m adverse variance).

• Continuing Care: The pressures within Free Nursing Care are mostly attributable to prior year costs and the monthlyexpenditure on Acquired Brain Injury patients almost doubling from April 2019.

• Better Care Fund: Collectively reconciles to budget, however in month an accrual went to Joint Funded MH rather than JointFunded Care Packages that will be rectified in the next reporting period. Joint Funded MH packages of care costs in excess ofthe pooled budget arrangements were anticipated, with a planned reserve, and therefore managed within available budgets.

• Unidentified QIPP: The QIPP plan for 2019/20 is £16.366m, however there is unidentified QIPP amounting to £11.750m.Reporting to NHS Northwest reflects the non delivery against the Unidentified QIPP target to date of £10m and forecast nondelivery in excess of £11m.

YTD Risk Rating : Red

FOT Risk Rating : Red

2. Financial Position YTD Financial Position Rating:

Red

Key Headlines

The financial position at month 11 is an adverse variance to the planned control total of £14.642m.Unidentified QIPP (£11.750m budget) within the financial plan is phased into the position equally acrossthe year. This equates to a negative budget within “Other Programme” of £10.083m for periods to date.

The areas of most significant adverse variances, excluding unidentified QIPP, are with Independent Sector,Non Contract Activity and collaborative sustainability adjustments within Acute. Within Community thecollaborative sustainability adjustment is driving the variance. Programme Projects and prior year FreeNursing Care pressures are also material.

RESOURCE LIMIT (YTD) 308.617

SECTOR REPORTING (ISFE) PLAN YTD ACTUAL YTD VARIANCE YTD VARIANCE

£m £m £m %

ACUTE SERVICES 165.067 168.910 -3.843 -2.3%

MENTAL HEALTH SERVICES 31.587 32.345 -0.758 -2.4%

COMMUNITY SERVICES 25.150 27.023 -1.873 -7.4%

CONTINUING CARE 17.177 17.933 -0.755 -4.4%

PRIMARY CARE 39.218 39.232 -0.013 0.0%

DELEGATED COMMISSIONING 25.634 25.359 0.275 1.1%

OTHER PROGRAMME 0.464 8.310 -7.846 -1691.3%

TOTAL COMMISSIONED SERVICES 304.298 319.110 -14.812 -4.9%

RUNNING COSTS 4.319 4.149 0.170 3.9%

TOTAL CCG POSITION YTD 308.617 323.259 -14.642 -4.7%

-833

-1,667

-2,500

-3,333

-4,167

-5,000 -5,833

-6,667

-7,500

-8,333 -9,167

-10,020

-1,889 -2,563

-3,174 -3,740

-4,421 -5,998 -6,740

-13,389

-14,745

-16,100

-14,745

-16,100

-18,000

-16,000

-14,000

-12,000

-10,000

-8,000

-6,000

-4,000

-2,000

-

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

£'0

00

NHS Warrington CCG 2019/20 Outturn Trajectories

Plan Net Risk Net Risk Trajectory Control Total System Recovery Trajectory

3. Financial Outturn Trajectories YTD Financial Position Rating:

Red

4. QIPP Position

The QIPP plan for 2019/20 is £16.366m,however unidentified QIPP accounts for£11.750m of this efficiency target.

The reporting profile to NHSE is different tothe profiling within the ledger, quarterlyversus monthly. Therefore within financialreturns to NHSE the YTD Unidentified QIPPvariance is £9.126m, however within theCCG financial position the YTD UnidentifiedQIPP variance is £10.083m.

The QIPP delivery against the Prescribingschemes tapered at month 10 based uponthe latest reports from the MedicinesManagement Team and expenditureperformance during 2019/20.

YTD Risk Rating : Red

FOT Risk Rating : Red

£m £m £m %

Acute Services 0.462 0.462 - 100.0 %

Mental Health Services 0.891 0.891 - 100.0 %

Continuing Care Services 0.444 0.444 - 100.0 %

Community Health Services 0.627 0.627 - 100.0 %

Primary Care Services 1.349 0.811 (0.538) 60.1 %

Other - 0.600 0.600 0.0 %

Unidentified QIPP 9.188 - (9.188) 0.0 %

TOTAL QIPP 12.961 3.835 (9.126)

Service Segment

Year to Date

Plan Actual Variance % Achieved

5. Risks and Mitigations

All known risks and mitigations are included within the forecast outturn position for February reporting.

This approach has been employed to support the national reporting requirements, with revised outturn targets being agreed and managed locally.

No further risks or mitigations have been included within reporting to NHS Northwest.

Since February reporting there have been significant national developments in relation to Coronavirus. Guidance from NHS England and Improvement are being issued to steer both Providers and Commissioners during this unprecedented time.

6. Conclusion

The development of financial plans, across the North West footprint, for the 2019/20 financial year to meet both theexpectations outlined within planning guidance and to secure the designated control totals proved a collective challenge.

For NHS Warrington CCG, this resulted in a financial plan being submitted with outlined risks of £10m against the deliveryof the control total. The largest proportion of the risk outlined at the planning stage was in relation to the level of QIPPthat had been included (£16.4m, or 13.4% of amenable budgets) with only 25% identified at that stage. This position hasnot improved throughout the financial year with Sustainability Contract arrangements prohibiting the application ofcashable savings against local partner contracts. The intent to optimise the system opportunities of minimising the systemdeficit and agreeing Sustainability contracts based on the real cost of delivery has resulted in a further deterioration in theCCGs financial position during 2019/20. However, this has secured c£15m of resilience funding for the system in Q3&4.

The focus on the delivery of system orientated opportunities has encouraged pathway redesign with partners, utilisingbenchmarking information from RightCare, GIRFT, and Model Hospital to inform priorities. The systems’ agreed prioritieshave been outlined as Frailty; Coronary Heart Disease; Chronic Pain; and Liver Disease. These prioritised schemes are notanticipated to deliver cashable savings to the commissioner(s) within the first year of the programme.


• Note the financial position at the end of February 2020;

• Note the revised outturn projections aligned to optimising the system financial position;

• Acknowledge the contributing factors within position, in particular the non delivery of QIPP and agreeingSustainability contracts based on the real cost of delivery ; and

• Note the application of the NHS Northwest protocol for deviations from assigned control totals during the month 11reporting period.

CORPORATE PERFORMANCE

REPORT

MARCH 2020

Red

Green

unknown

Achieving target

Adverse variance to target

No target set

1 NHS HALTON & NHS WARRINGTON CCG

CORPORATE PERFORMANCE REPORT – MARCH 2020

EXECUTIVE SUMMARY

KEY

Actual performance Target Long term trend

Introduction This report provides the CCG with information on the key strategic and operational issues and developments related to the CCG's statutory requirements. The data reported here is as defined and reported in the NHS operational plan, there may be some differences between the activity levels reported in the plan and those agreed in the contracts with providers due to differing technical guidance.

Coronavirus - Covid 19 This report shows data around 6-10 weeks in arrears, as such much of the activity and performance reported here relates to the period prior to the outbreak of the Coronavirus pandemic. A number of providers have already stated that they are seing an impact on day to day operations and national directions in relation to planned care will also begin to be seen in this report from next month.

Overall Assessment March report, detailing performance in January and February Urgent Care Urgent care services are under severe pressure with all but one activity plans being missed for both Warrington and Halton CCG's and almost all performance standards also being missed. The reducing attendances at the UCC's has been halted however significant increases have yet to be seen, some improvement has been seen in ambulance response times however the national standards are still being missed. Planned Care With respect to planned care, Warrington Trust is performing well against the national standards, outperforming the national average, however capacity issues at some Merseyside Trusts are impacting on Halton and Warrington CCG residents, These capacity issues have been addressed however it may take some time for the backlog of patients to be treated and. Cancer The Cancer standards are being achieved YTD from a Trust perspective, however previous breast and dermatology capacity issues at STHK mean that Halton CCG is failing both two week wait standards. Cancer Commissioning and clinical leads are in regular dialogue with local trusts to discuss individual breaches however some issues remain in Merseyside providers. Mental Health Whilst performance against the Dementia standards remains strong, performance against IAPT standards is below the national standard and below that achieved last year for both CCG's. This is the subject of ongoing discussions with the provider, however recruitment and retention difficulties means that any improvement may not be seen until towards the end of 2019/20 and no improvement is expected in the short term.

65%

35%

Headline Assessment - Performance

Halton Warrington CCG

Warrington

50%

50%

30%

70%

The percentage of measures achieving plan YTD

Headline Assessment - Activity The percentage of actual activity achieving plan YTD

Halton Warrington CCG

Warrington Trust

67%

33%

67%

33%

11%

89%

Year To Date Overview

2 NHS HALTON CCG & NHS WARRINGTON CCG


URGENT CARE AT A GLANCE

NHS Halton CCG and NHS Warrington CCG are committed to ensuring that performance against constitutional measures and outcomes are consistently and rigorously maintained. It should be noted that not all of the indicators are reflected in the Corporate Performance Report.

Emergency admissions v plan non-elective admissions have increased in both CCG's and WHHFT, most noticeable however in Warrington, Activity growth exceeds expected levels for all emergency admissions, with zero length of stay impacted by FAU & increased assessment area capacity at local providers. Actions Discussions are being held with the local trust to determine the main drivers for the activity and whether the trend is anticipated to continue. The opening of a new combined assessment unit at WHHFT may increase numbers further in future months Multiple same day emergency admissions has also been raised as an issue at STHK and may also be linked to admissions from assessment units.

Ambulance Response Times Performance figures have improved, this has been linked to the reduction in demand of ambulances which, in turn, has been linked to patients concerns around going into hospital in light of Coronavirus. Actions The service still needs to make further internal efficiencies to create extra resources so that all the standards are achieved. The introduction of the new rotas is going well, these should be in place in May 2020 Activity is close to plan and if the recent reduction in activity continues there will be a significant reduction in activity year on year.

Halton CCG Warrington CCG

Trust

A&E attendances v plan

Emergency admissions (NEL) v plan

Admissions for urgent care sensitive conditions

Delayed Transfers of Care

Ambulance Response Times - Category 1

A&E Waiting time performance

COVID-19 NHS 111 As a result of NHS 111 supporting Covid-19 a significant increase in activity has been seen, instructions have been included at the begining of the each call to ensure that the caller reaches the correct line of support. Also due to the levels of activity calls answer times are being delayed, callers are asked to be patient and wait for their call to be answered rather than abandoning the call. 999 calls At this time an increase in 999 activity has not been seen. Emergency Ambulance Attendances A significant reduction in activity has been seen, Since the end of janaury thre has been a direct correlation between activity levels and pateints concerens around going into hospitals in light of Coronavirus. This is equalvalent to 6-10% reduction in year-on-year activity

TARGET

07:00

TARGET18:00

TARGET

95.0%

Jan-20 84.5% 74.0% 76.1%

Feb-20 08:22 08:15 07:21

Feb-20 22:05 21:02 24:58



PERFORMANCE AGAINST NHS OPERATIONAL PLAN

Category 1 average response time

Category 2 average response time

Percentage pf patients admitted, transferred or discharged from A&E in 4-hours

URGENT CARE

Halton CCG Warrington CCG NWAS Trust

Performance figures have improved, this has been linked to the reduction in demand of ambulances which, in turn, has been linked to patients concerns around going into hospital in light of Coronavirus.

Trend

Warrington CCG Halton CCG NWAS Trust Trend

Category 2 calls account for 55% of all ambulance calls and although imprvements have been seen the targets are being missed. The service still needs to make further internal efficiencies to create extra resources so that all the standards are achieved. The introduction of the new rotas is going well, these should be in place in May 2020

Warrington CCG Halton CCG Warrington Trust Trend

The pattern of deteriorating waiting time performance seen nationally is also visible in Halton and Warrington. Warrington CCG and Warrington & Halton Trust figures closely correlate which is to be expected and due to patient flow. Halton performance is significantly higher due to the number of residents using the UCC's in Widnes and Runcorn with much shorter waiting times

AMBULANCE RESPONSE TIMES

AMBULANCE RESPONSE TIMES:

4-HOUR A&E WAITS: 127C

04:19

05:46

07:12

08:38

10:05

11:31

12:58


NWAS

14:24

21:36

28:48

36:00

43:12


NWAS

07:00

09:54

08:37

08:43

Target

17/18

18/19

19/20 YTD

07:00

07:59

08:02

08:08

Target

17/18

18/19

19/20 YTD

18:00

30:39

24:33

24:25

Target

17/18

18/19

19/20 YTD

18:00

22:50

23:07

22:30

Target

17/18

18/19

19/20 YTD

95.0%

93.0%

90.1%

85.7%

Target

17/18

18/19

19/20 YTD

95.0%

85.1%

80.5%

77.7%

Target

17/18

18/19

19/20 YTD60%

80%

100%

Halton CCG -Local calculationNHS Warrington CCG - Local calculationWarrington Trust

95.0%

88.0%

82.3%

80.1%

Target

17/18

18/19

19/20 YTD

07:00

07:54

07:57

07:15

Target

17/18

18/19

19/20 YTD

18:00

24:15

24:26

24:25

Target

17/18

18/19

19/20 YTD

TARGET

Various

TARGET

Various

TARGETVarious

Jan-20 3058 5295 6613

Jan-20 4595 1246 2096

Jan-20 1713 2415 3199




Number of attendances at Type 1 A&E Department

Number of attendances at Type 3 & 4 A&E Departments

Total non-elective FFCEs in General & Acute Specialties

URGENT CARE

Halton CCG Warrington CCG Warrington Trust

Year-on-year comparisons show continued increasing demand on type 1 A&E departments At the same time demand on type 3 sites remains flat or falling. Some improvement has been seen in the last two months with the number of attendances at the type 1 sites no longer increasing at the same rate and the number of attendances at the type 3 sites not decreasing at the same rate.

Trend


The previous falls in type 3 attendances appear to have now stabalised and are no longer falling. There has been no significant growth. The UTC service specification at the Runcorn site begins in April and it is anticipated that a significant increase i n atendances at this site will be seen.


Both Halton and Warrington CCG's have witnessed increases in non-elective admissions, this is predominantly driven by increases in admissions at WHHFT, this has a proportionately larger effect on the Warrington CCG figures. This increase is attributed primarily to the admissions recorded at the assessment units.

A&E (Type 1) ATTENDANCES

A&E (Type 3 ) ATTENDANCES

NON ELECTIVE ADMISSIONS

0

1,000

2,000

3,000

4,000


Warrington Trust

2,737

2,674

2,762

3,058

Jan 20 Target

Jan-18

Jan-19

Jan-20

4,996

4,773

5,070

5,295

Jan 20 Target

Jan-18

Jan-19

Jan-20

6,598

5,918

6,261

6,613

Jan 20 target

Jan-18

Jan-19

Jan-200

2,000

4,000

6,000

8,000

10,000

Halton CCG totalNHS Warrington CCG totalWARRINGTON TRUST

5,098

5,225

4,513

4,595

Jan 20 Target

Jan-18

Jan-19

Jan-20

1,496

1,256

1,343

1,246

Jan 20 Target

Jan-18

Jan-19

Jan-20

0

2,637

2,495

2,096

Jan 20 target

Jan-18

Jan-19

Jan-20-2,000

0

2,000

4,000

6,000

Halton CCG total Warrington

Warrington Trust

16,717

14,899

15,884

16,680

Target

17/18 YTD

18/19 YTD

19/20 YTD

21,815

21,718

20,625

24,503

Target

17/18 YTD

18/19 YTD

19/20 YTD

0

27,783

25,813

30,766

Target

17/18 YTD

18/19 YTD

19/20 YTD

TARGET

Various

TARGET

Various

Jan-20 645 1032 1350

Jan-20 1068 1383 1849




Total non-elective FFCEs in General & Acute Specialties with a 0 day LOS

Total non-elective FFCEs in General & Acute Specialties with a 1+ day LOS

URGENT CARE

Halton CCG Warrington CCG Warrington Trust

Zero day length of stay admissions have been flat at Halton CCG and are slightly below plan. The number of admissions for Warrington CCG has increased and is significantly above the plan set.

Trend


Increases in non elective admissions have been seen in both zero LOS and 1+ LOS. Both CCG's are above plan and above last years actuals, the increases seen in the Trust accelerated in January.

NON ELECTIVE ADMISSIONS 0 LOS

NON ELECTIVE ADMISSIONS 1+ LOS

0

500

1,000

1,500

2,000

Halton CCG NHS Warrington CCG

Warrington Trust

0

500

1,000

1,500

2,000


Warrington Trust

7,020

6,153

6,812

6,922

Target

17/18 YTD

18/19 YTD

19/20 YTD

9,080

0

10,520

11,041

Target

17/18 YTD

18/19 YTD

19/20 YTD

0

12,122

10,529

14,105

Target

17/18 YTD

18/19 YTD

19/20 YTD

9,697

8,388

8,664

9,753

Target

17/18 YTD

18/19 YTD

19/20 YTD

12,735

0

13,211

13,462

Target

17/18 YTD

18/19 YTD

19/20 YTD

0

15,661

15,284

16,661

Target

17/18 YTD

18/19 YTD

19/20 YTD

ENG AVE

2497

ENG AVE

2211

ENG AVE

982

19/20 Q2 3581 3103

19/20 Q2 2752 3134

19/20 Q2 1,136 1,228




Rate of unplanned hospital admissions for urgent care sensitive conditions, per 100,000 registered patients.

Difference in age and sex standardised rate of unplanned hospitalisation for chronic ambulatory care sensitive conditions per 100,000 population, between the most and least deprived LSOAs

Total length of all emergency admissions per 1,000 population, adjusted for age, sex and need.

URGENT CARE


NHSE have corrected the erroneously published data from January, this has had no material impact on the CCG's position compared to the national average however the step change witnessed has now been removed. Both CCGs' show a deteriorating position in relation to Urgent Care Sensitive Condition admissions.

Trend

Warrington CCG Halton CCG Trend

NHSE have corrected the erroneously published data from January, this has had no material impact on the CCG's position compared to the national average however the step change witnessed has now been removed. Warrington CCG has seen in increase in the inequality of unplanned admissions over the last 12 months compared to a decrease seen in Halton, to the extent that the inequality is now greater in Warrington CCG for the first time.


Both CCG's have seen an improvement in the use of hospital beds following admission, this is due to the increasing number of zero day length of stay admissions.

ADMISSIONS FOR UCSC: 127B

INEQUALITY IN UNPLANNED ADMISSIONS: 106A

USE OF HOSPITAL BEDS FOLLOWING ADMISSION: 127F

2,497

3,818

3,786

3,422

3,581

Eng Ave

16/17 Q2

17/18 Q2

18/19 Q2

19/20 Q2

2,497

3,228

3,350

2,736

3,103

Eng Ave

16/17 Q2

17/18 Q2

18/19 Q2

19/20 Q2

0

1000

2000

3000

4000

5000

15/16Q4

16/17Q1

16/17Q2

16/17Q3

16/17Q4

17/18Q1

17/18Q2

17/18Q3

17/18Q4

18/19Q1

18/19Q2

18/19Q3

18/19Q4

19/20Q1

19/20Q2

Halton Warrington England Ave

2,211

3,584

3,793

3,238

2,752

Eng Ave

16/17 Q2

17/18 Q2

18/19 Q2

19/20 Q2

2,211

3,385

3,190

2,533

3,134

Eng Ave

16/17 Q2

17/18 Q2

18/19 Q2

19/20 Q2

0

1000

2000

3000

4000

5000

15/16Q4

16/17Q1

16/17Q2

16/17Q3

16/17Q4

17/18Q1

17/18Q2

17/18Q3

17/18Q4

18/19Q1

18/19Q2

18/19Q3

18/19Q4

19/20Q1

19/20Q2


982

1,139

1,147

1,199

1,136

Eng Ave

16/17 Q2

17/18 Q2

18/19 Q2

19/20 Q2

982

1,195

1,170

1,249

1,228

Eng Ave

16/17 Q2

17/18 Q2

18/19 Q2

19/20 Q2

500

700

900

1100

1300

1500

15/16Q4

16/17Q1

16/17Q2

16/17Q3

16/17Q4

17/18Q1

17/18Q2

17/18Q3

17/18Q4

18/19Q1

18/19Q2

18/19Q3

18/19Q4

19/20Q1

19/20Q2


ENG AVE

22.70

ENG AVEN/A

Dec-19 15.00 5.80

Jan-20 620 391 432




Average Delayed transfers of care (delayed days) per day for all reasons per 100,000 population .

Total number of Delayed Transfer of Care days

URGENT CARE



There was a large increase in January for Halton, this was driven by Warrington and Liverpool University Hospitals. Although the breaches for Halton were recorded as NHS attributable delays 140 delayed days were attributed to patients waiting for a care package in their own home.

DELAYED TRANSFERS OF CARE: 127E

DELAYED TRANSFERS OF CARE - DAYS:

22.70

12.50

10.90

15.00

Dec 19 Target

Dec-17

Dec-18

Dec-19

12.12

12.00

12.70

5.80

Dec 19 Target

Dec-17

Dec-18

Dec-19

Halton Benchmark Warrington Benchmark

Warrington Trust

437

390

190

620

Jan 20 target

Jan-17

Jan-18

Jan-20

0

642

462

391

Jan 20 target

Jan-17

Jan-18

Jan-20

0

655

400

432

Jan 20 target

Jan-17

Jan-18

Jan-200

500

1,000

1,500

2,000

2,500

Halton LA Warrington UA

Warrington Trust




PLANNED CARE AT A GLANCE


Activity Both CCG's have witnessed a small increase in the number of outpatient attendances, +2% in Halton, +0.7% in Warrington. Whilst this is inline with the plan for Warrington this is significantly above plan (+6%) for Halton this is due to a large number of outpatient attendances being removed from the plan due to QIPP schemes which have not fully delivered in 2019/20. There has been a reduction in overnight inpatient elective admissions and an increase in the number of day case admissions at both CCG's, with a 5% reduction in overnight admissions and a 6% increase in day case admissions in Halton CCG and a 12% reduction in overnight admissions and a 8% increase in Day case admissions in Warrington CCG.


Warrington

18- Week RTT

52-Week Breaches

6-Week Diagnostics

Planned Care Waiting list

18 Week RTT Both Warrington & Halton CCG's missed the RTT standard in January although WHHFT did meet the standard, performance is declining, this is due to a number of factors including; routine electives postponed to support emergency pressures, consultant sickness, HMRC pay cap and the lack of uptake of WLI's Actions The Trust is carrying out a number of actions in various specialties to improve RTT performance, these include; General Surgery: Capacity and demand piece of work currently underway. Service is also interviewing for a 10th consultant. Urology: business case due to be presented for a fifth consultant to meet capacity and demand T&O: Work stream supporting the increase of capacity, a hot week review to be carried out, this could enable an increase of hot week patients through CMTC. Locum joining for 6 months, within the upper limb specialty which is our main area of pressure. ENT: CBU will be presenting a business case for a fourth consultant to meet current demand Ophthalmology: 2 consultant post out for advert.2 nurses are due to go on training course in May for injections all which will improve performance. There were 59 theatre cancellations on the day between October and January which has had an impact on performance. This is currently being reviewed in the Pre-Op work stream and locally within the CBU. 52-Week Breaches There were no 52-week breaches in January 6-Week Diagnostic Waits Warrington & Halton Trust and the Warrington CCG both comfortably achieve the national standard for diagnostic waits. Halton is missing the standard due to the long waiting times for CT's and MRI's at Liverpool Heart & Chest. Actions Additional machines were operational from November, however the Trust is working through a backlog and improvements may not be seen until early 2020

TARGET

92%

TARGET

Various

TARGET

1.00%

Jan-20 91.63% 91.80% 92.10%

Jan-20 10405 15861

43,831 1.78% 0.70% 0.12%




The percentage of patients waiting to start non-emergency consultant led treatment who were waiting 18 weeks or less - Trust data 1 month behind CCG data

.

The total number of incomplete RTT pathways at the end of the reporting period

The number of patients waiting six weeks or more for a diagnostic test as a percentage of the total number of patients waiting

PLANNED CARE


Both Warrington & Halton CCG's missed the RTT standard in January although WHHFT did meet the standard, performance is declining, this is due to a number of factors including; routine electives postponed to support emergency pressures, consultant sickness, HMRC pay cap and the lack of uptake of WLI's. The Trust is carrying out a number of actions covering indivudual specialties including the recruitment of additional consultants.

Warrington CCG Halton CCG

Both CCG's have missed the January 2020 waiting list target, however Halton CCG has seen a small reduction compared to the same month last year. Warrington CCG has seen a 5% increase in the waiting list. The actiions being carried out by The Trust to reduce waiting times will also ultimately lead to a reduction in the waiting list, however this may not happen before the end of the year.


Warrington & Halton Trust and the Warrington CCG both comfortably achieve the national standard for diagnostic waits. Halton is missing the standard due to the long waiting times for CT's and MRI's at Liverpool Heart & Chest. Additional machines were op erational from November, however the Trust is working through a backlog and improvements may not be seen until early 2020

18 WEEK REFERRAL TO TREATMENT (RTT): 129A

RTT WAITING LIST 124B

6 WEEK DIAGNOSTIC WAIT: 133A

Warrington Trust

92.00%

93.20%

93.28%

92.27%

Target

17/18

18/19

19/20 YTD

92.00%

92.68%

92.45%

92.17%

Target

17/18

18/19

19/20 YTD

92.00%

92.73%

91.79%

91.75%

Target

17/18

18/19

19/20 YTD

Trend

90%

91%

91%

92%

92%

93%

93%

94%

94%

95%

95%

Halton CCG TargetWarrington CCG WHHFT

Trend

10,373

9,496

10,449

10,405

Target Jan 20

Jan-18

Jan-19

Jan-20

14,331

14,385

15,091

15,861

Target Jan 20

Jan-18

Jan-19

Jan-20 0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000


Halton plan Warrington Plan

Warrington Trust

1.00%

0.67%

1.26%

1.24%

Target

17/18

18/19

19/20 YTD

1.00%

0.77%

0.97%

0.50%

Target

17/18

18/19

19/20 YTD

1.00%

0.41%

0.77%

0.14%

Target

17/18

18/19

19/20 YTD

Trend

0%

1%

1%

2%

2%

3%

3%

Halton CCG Target

Warrington CCG Warrington Trust

TARGET

Various

TARGET

Various

TARGET

Various

Jan-20 249 321 322

Jan-20 2769 4705 3539

Jan-20 4382 6321 5869


CORPORATE PERFORMANCE REPORT –MARCH 2020


GP written referrals for a first outpatient appointment in G&A specialties (MAR) - Provider data 1 month behind Commissioner Data

.

All first outpatient activity G&A specialties (MAR) - Provider data 1 month

behind Commissioner Data

Total ordinary elective admissions in general & Acute specialties - Provider data 1 month behind Commissioner Data

PLANNED CARE


Both CCG's have seen a reduction in the number of GP referrals YTD and are below plan.


Both CCG's have witnessed a small increase in the number of outpatient attendances, +2% in Halton, +0.7% in Warrington. Whils t this is inline with the plan for Warrington this is significantly above plan (+6%) for Halton this is due to a large number of outpat ient attendances being removed from the plan due to QIPP schemes which have not fully delivered in 2019/20.


There has been a reduction in overnight inpatient elective admissions and an increase in the number of day case admissions at both CCG's, with a 5% reduction in overnight admissions and a 6% increase in day case admissions in Halton CCG and a 12% reduction in overnight admissions and a 8% increase in Day case admissions in Warrington CCG.

GP REFERRALS

FIRST OUTPATIENT APPOINTMENTS

ELECTIVE ORDINARY ADMISSIONS

Warrington Trust Trend

0

1,000

2,000

3,000

4,000

5,000

6,000

Halton CCG Warrington CCGWarrington Trust

Trend


0

100

200

300

400

500


Warrington Trust

28,709

26,280

27,744

27,604

Target

17/18 YTD

18/19 YTD

19/20 YTD

46,879

43,606

46,517

45,256

Target

17/18 YTD

18/19 YTD

19/20 YTD

0

40,863

40,422

40,217

Target

17/18 YTD

18/19 YTD

19/20 YTD

Warrington Trust

39,796

38,622

41,405

42,215

Target

17/18 YTD

18/19 YTD

19/20 YTD

59,730

57,621

58,871

59,298

Target

17/18 YTD

18/19 YTD

19/20 YTD

0

59,391

57,036

57,388

Target

17/18 YTD

18/19 YTD

19/20 YTD0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

Halton CCG Warrington CCGWarrington Trust

2,151

2,540

2,370

2,241

Target

17/18 YTD

18/19 YTD

19/20 YTD

4,140

3,940

3,904

3,419

Target

17/18 YTD

18/19 YTD

19/20 YTD

0

3,491

3,353

2,826

Target

17/18 YTD

18/19 YTD

19/20 YTD

TARGET

Various

Jan-20 1595 2248 2102




A patient admitted electively during the course of a day who does not require the use of a bed overnight and who returns home as scheduled .

PLANNED CARE


There has been a reduction in overnight inpatient elective admissions and an increase in the number of day case admissions at both CCG's, with a 5% reduction in overnight admissions and a 6% increase in day case admissions in Halton CCG and a 12% reduction in overnight admissions and a 8% increase in Day case admissions in Warrington CCG.

DAYCASE ADMISSIONS


0

500

1,000

1,500

2,000

2,500

3,000


Warrington Trust

13,933

14,240

14,189

15,006

Target

17/18 YTD

18/19 YTD

19/20 YTD

20,383

20,005

19,240

20,864

Target

17/18 YTD

18/19 YTD

19/20 YTD

0

22,113

20,260

20,831

Target

17/18 YTD

18/19 YTD

19/20 YTD




CANCER AT A GLANCE


62-Day Treatment - from NHS Screening Three breaches for Warrington CCG (two of these shared across two providers) All were lower gastro patients first seen at Aintree. Two patients were delayed due to a complex diagnostic pathway, the third reason was recorded as 'due to inadequate inpatient capacity'. It wasn't that there was not sufficient capacity, the Treating Trust (WHHFT) only had six days to treat in and the patient couldn't be seen in that time. Actions There appears to be a trend developing whereby patients are being referred late from Aintree into the treating Trust; we believe this is due to an increased demand because of the introduction of FIT testing within the bowel screening programme. This will be raised at C&M level to have a system to the current position and escalation if required.

2 Week Wait This metric is not formally reported nationally due to Warrington & Halton Trust being part of the pilot for the 28 day faster diagnosis standard, however unofficial local report suggests that the two week wait standard continues to be achieved. The breaches at Halton CCG are due to seasonal deteriorations in Dermatology due to increases in referrals in the summer months to STHK Trust, and historical breaches due to a reduction in specialist breast cancer consultant capacity, this has now been resolved, however it is unlikely that the YTD performance will reach the national standard by the end of March. Actions Warrington CCG and Warrington & Halton Hospitals Foundation Trust both consistently achieve the national standard The Dermatology breaches at St Helens have been raised by the Halton CCG cancer commissioning lead with STHK Trust. Halton CCG have introduced a local dermatology service which is reducing overall referrals for Dermatology. 31 Day Treatment Overall YTD standards are being consistently achieved across both CCG's and Warrington Trust. 62 Day Treatment NHS Halton CCG saw 4 breaches across 4 different providers (one breach was shared), 3 of the 4 breaches relate to Head & neck cancers. These are often the most complex cancers to treat. No patient waited more than 85 days unfortunately "other reasons" as the reason for the delay was used in all four breaches. Actions With the differing numbers of providers involved, it is difficult to understand each patient pathway. We will monitor performance again next month to see whether there is further variation to cause concern.


Warrington

Two Week Waits

Two Week Waits - Breast Symptoms

31 Day Treatment

62 Day Treatment

TARGET

93.0%

TARGET

93.0%

TARGET

96.0%

92.4%

96.7%Jan-20 96.8%

Jan-20 94.4%

Jan-20 93.9% 93.9%

95.4%

94.2%

94.4%

12

NHS HALTON CCG & NHS WARRINGTON CCG CORPORATE PERFORMANCE REPORT –MARCH 2020


The % patients seen within two weeks for an urgent GP referral for suspected cancer

93.0%

94.2%

92.3%

91.7%

Target

17/18

18/19

19/20 YTD

Two week wait standard for patients referred with breast symptoms not covered by two week wait for breast cancer

93.0%

94.4%

93.6%

91.5%

Target

17/18

18/19 YTD

19/20 YTD

The % of patients receiving their first definitive treatment within one month of diagnosis

96.0%

96.0%

97.5%

96.0%

Target

17/18

18/19

19/20 YTD

CANCER


93.0%

94.1%

94.7%

94.4%

Target

17/18

18/19

19/20 YTD

Warrington Trust

93.0%

94.0%

93.8%

93.8%

Target

17/18

18/19

19/20 YTD

Warrington CCG and Warrington & Halton Hospitals Foundation Trust both consistently achieve the national standard The Dermatology breaches at St Helens have been raised by the Halton CCG cancer commissioning lead with STHK Trust. Halton CCG have introduced a local dermatology service which is reducing overall referrals for Dermatology

Trend


93.0%

91.1%

92.6%

92.2%

Target

17/18

18/19 YTD

19/20 YTD

93.0%

91.2%

92.8%

94.1%

Target

17/18

18/19 YTD

19/20 YTD

The historcial breaches are due to a reduction in specialist breast cancer consultant capacity, this has now been resolved, h owever it is unlikely that the YTD performance will reach the national standard by the end of March.

Warrington CCG Halton CCG Warrington Trust

96.0%

97.2%

96.8%

96.6%

Target

17/18

18/19

19/20 YTD

96.0%

98.1%

99.0%

99.0%

Target

17/18

18/19

19/20 YTD

Trend

Overall YTD standards are being consistently achieved across both CCG's and Warrington Trust.

TWO WEEK WAITS:

TWO WEEK WAIT - BREAST:

31 DAY TREATMENT:

85%

90%

95%

100%


Warrington Trust

70%

75%

80%

85%

90%

95%

100%


Warrington Trust

90%

92%

94%

96%

98%

100%


Warrington Trust

TARGET

85.0%

Eng Ave

8.8

TARGET

52.2%

2017 52.3% 51.0%

Jan-20 81.8% 85.4% 85.6%

2018 8.75 8.76


CORPORATE PERFORMANCE REPORT –MARCH 2020


The % of patients receiving 1st definitive treatment for cancer within 2 months (62 days)

85.0%

80.1%

85.9%

82.6%

Target

17/18

18/19

19/20 YTD

Average score given to the question “Overall, how would you rate your care?” on a scale from 0 (very poor) to 10 (very good)

New cases of cancer diagnosed at stage 1 and 2 as a proportion of all new cases of cancer diagnosed

CANCER


85.0%

83.6%

85.4%

83.6%

Target

17/18

18/19

19/20 YTD

Warrington Trust

85.0%

83.3%

86.8%

86.8%

Target

17/18

18/19

19/20 YTD

NHS Halton CCG saw 4 breaches across 4 different providers 3 of the 4 breaches relate to Head & Neck cancers. These are often the most complex cancers to treat. With the differing numbers of providers involved, it is difficult to understand each patient pathway. The CCG will monitor performance again next month to see whether there is further variation to cause concern

Trend


This measure is included in the NHS Oversight Framework. Both Warrington and Halton CCG perform very close to the England average (no statistically significant difference) Both CCG's rating is also close the their respective peer group average.


The most recent available data for this metric is for 2017. Halton CCG achieved the required standard. Warrington was slightly below the standard but remained interquartile both nationally and with their peer group.

62 DAY TREATMENT WAIT 122B

CANCER EXPERIENCE 122D

EARLY CANCER DIAGNOSIS 122A

70%

75%

80%

85%

90%

95%

100%


Warrington Trust

8.80

8.98

8.77

8.75

England Average

2016

2017

2018

8.80

8.57

8.69

8.76

England…

2016

2017

2018


52.2%

50.0%

49.0%

52.3%

Eng. Ave

2015

2016

2017


52.2%

51.0%

48.0%

51.0%

Eng. Ave

2015

2016

2017

Year to Date Overview



MENTAL HEALTH AT A GLANCE


IAPT Both CCG's are missing target, however whilst Halton CCG has witnessed an improvement in performance, Warrington CCG has seen a deterioration. Actions Warrington CCG - Cheshire & Mersey came together in a summit in Feb 20 to agree a number of actions to improve performance on access and recovery across the wider footprint., actions from the summit include an STP-wide approach to recruitment of trainees Halton CCG - Halton we are now seeing the impact of the implementation of the local remedial action plan although it is unlikely the required target for qtr. 4 19/20 will be met. Early Intervention In Psychosis The Data Collection Board (DCB) has now approved the decommissioning of the interim collection of Early Intervention in Psychosis (EIP) waiting times information. This will still be collected however there does appear to be a delay in this reaching the CCG through the usual channels. Based on the most recent data available both CCG's are comfortably achieving the standard YTD Actions The CCG to liaise with the CSU to ensure access to timely data The CCG's are in discussion with provider regarding process for a business case for further investment to maintain delivery

Dementia Diagnosis Both CCG's current perform above the expected standard however further actions are being planned to improve rates further. Actions Halton CCG are hopeful the embedding of a new dementia referral form which requires current scan and blood tests will ensure CCG meet the 6 week referral to diagnosis target and have the knock effect of increasing diagnostic rate. Dementia Care Plan Annual review No national standard has been set. Halton CCG performs above the national average and is in the top quartile in its peer group. Warrington perform below the national average and are 2nd lowest in their peer group, however this performance relates to 18/19. Actions NHS Halton CCG plan to maintain the existing level of performance NHS Warrington CCG plan to obtain up to date data in order to ascertain what action needs to be taken..


Dementia Diagnosis

Dementia Care Planning

IAPT Access

IAPT recovery

Out Of Area Placements Both CCG's OOA acute placements are significantly below English average Actions The CCG's have a 'risk share' arrangement with the provider to manage cases.

TARGET

66.7%

ENG AVE

78.0%

TARGET

5.5%

Feb-20 5.0% 3.6%

19/20 YTD 71.9% 76.2%

18/19 79.5% 75.8%




Number of people aged 65 and over on the dementia register divided by the estimated prevalence rate

The percentage of patients diagnosed with dementia whose care plan has been reviewed in a face-to-face review in the preceding 12 months

The proportion of people that enter treatment against the level of need in the general population

MENTAL HEALTH


Both Warrington and Halton CCG's comfortably exceed the target of 66.7%, however Warrington CCG consistently achieves a higher diagnosis rate than Halton CCG and is placed in the top quartile of its peer group compared to inter-quartile for Halton CCG. Halton is acheiving the national standard but marginally missing the locally set ambition.


No national standard has been set. Halton CCG performs above the national average and is in the top quartile in its peer grou p. Warrington perform below the national average and are 2nd lowest in their peer group, however this performance relates to 18/19.


Whilst nationally the target is increasing, the performance at Warrington and Halton CCG's has shown a deterioration. Halton has seen an improvement in recent months from historically low levels. Appropriate capacity within the system appears to be limiting the number of places available for treatment. NOTE: the different CCG targets are the result of operational plan setting

DEMENTIA DIAGNOSIS: 126A

DEMENTIA CARE PLANNING: 126B

IAPT ACCESS: 123B

0%

2%

4%

6%

NHS Halton CCG Rolling Quarters - Local Data

NHS Warrington CCG Rolling Quarters - Local Data

71.5%

69.6%

73.6%

71.9%

Target

17/18

18/19

19/20 YTD

66.8%

71.0%

76.0%

76.2%

Target

17/18

18/19

19/20 YTD


78.0%

77.1%

79.9%

78.6%

79.5%

Eng Ave

15/16

16/17

17/18

18/19

77.5%

78.0%

77.1%

81.7%

75.8%

Eng Ave

15/16

16/17

17/18

18/19


5.5%

4.3%

5.3%

5.0%

Target

17/18 Q4

18/19 Q4

19/20 YTD

5.0%

4.3%

4.8%

3.6%

Target

17/18 Q4

18/19 Q4

19/20 YTD

TARGET

50.0%

TARGET

75.0%

ENGLAND

159

Feb-20 46.2% 50.3%

Nov-19 75.0% 50.0%

Nov-19 10 49




The percentage of people who finished treatment within the reporting period ... who are assessed as moving to recovery

The percentage of people referred to service experiencing first episode psychosis or at “risk mental state” that start care within 2 weeks

The rate of inappropriate Out of Area Placements (OAPs) in mental health services for adults in non-specialist acute inpatient care per 100,000 population

MENTAL HEALTH


Both Halton and Warrington CCG's have witnessed a reduction in IAPT recovery rates over 2019, however the reduction seen in Halton has been much more marked and the CCG is now significantly below the target level. The recovery rate seen in Warrington is achieving the national target and is significantly higher than that seen in Halton.


The Data Collection Board (DCB) has now approved the decommissioning of the interim collection of Early Intervention in Psychosis (EIP) waiting times information. This will still be collected however there does appear to be a delay in this reaching the CCG through the usual channels. The CCG will liaise with the CSU to ensure access to timely data


Both CCG's OOA acute placements are significantly below English average. The CCG's have a 'risk share' arrangement with the provider to manage cases.

IAPT RECOVERY: 123A

PSYCHOSIS TWO WEEK WAIT: 123C

MH OOA PLACEMENTS: 123F

50.0%

51.4%

48.1%

46.2%

Target

17/18

18/19

19/20 YTD

50.0%

51.1%

52.9%

50.3%

Target

17/18

18/19

19/20 YTD

Trend

30%

40%

50%

60%

NHS Halton CCG Rolling Quarters - Local Data

NHS Warrington CCG Rolling Quarters - Local Data

75.0%

82.5%

80.0%

85.2%

Target

17/18

18/19

19/20 YTD

57.1%

78.4%

81.8%

80.6%

Target

17/18

18/19

19/20 YTD30%

50%

70%

90%

110%


Trend

159

39

0

0

10

ENGLAND

Apr-18

Apr-19

Jul-19

Nov-19

159

0

0

3

49

ENGLAND

Apr-18

Apr-19

Jul-19

Nov-19


ENG AVE

58

ENG AVE

51.4%

ENG AVE

0.49%

19/20 Q2 51 51

18/19 54.2% 40.3%

17/18 0.62% 0.62%




The number of adult inpatients per million ONS resident adult population from the CCG (based on CCG of origin). .

Proportion of people with a learning disability on the GP register receiving an annual health check.

The Proportion of the population that are included on a GP register

LEARNING DISABILITIES


This metric is calculated as a rate per million population at a Transforming Care Partnership (TCP) level and applied to all CCG's in that TCP, Warrington and Halton will threfore be given the same rate.



Both CCG's perform aboive the England average.

SPECIALIST INPATIENT STAYS: 124A

LEARNING DISABILITY HEALTH CHECKS: 124B

COMPLETENESS OF THE LEARNING DISABILITY REGISTER: 124C


51.4%

35.2%

58.8%

59.5%

54.2%

17/18 Eng Ave

15/16

16/17

17/18

18/19

51.4%

36.4%

49.3%

54.2%

40.3%

17/18 Eng Ave

15/16

16/17

17/18

18/19


0.49%

0.62%

0.62%

0.62%

17/18 Eng Ave

16/17

17/18

18/19

0.49%

0.47%

0.46%

0.62%

17/18 Eng Ave

16/17

17/18

18/19


58

51

England Ave

C&M TCP

SPECIALIST INPATIENT ACCOMODATION - C&M

TCP (rate per million population)

ENG AVE

39.1%

ENG AVE

12.1%

ENGLAND

57.3%

2019 55.6% 59.6%

2017/18 37.8% 41.7%

2017-18 11.7% 1.6%




The percentage of diabetes patients who have achieved all the NICE recommended treatment targets.

People with diabetes diagnosed less than a year who attend a structured education course

The proportion of carers with long term conditions who feel supported to manage their conditions

LONG TERM CONDITIONS


Halton CCG is working towards putting in place a Halton diabetes community service model. The business model will use a multi-disciplinary approach to ensure the most complex patients get the appropriate care through a single point of access. The pilot model will look to ensure improvements in the most complex patients initially, and then be developed towards supporting a greater number of Halton diabetic patients to achieve the 3 treatment targets. The expectation is this service model will be in operation by 2020/21


Halton CCG and partners have developed a new primary care pathway for diabetes. The biggest change is that this is no longer an opt-out service, all Halton T2 patients will be given lifestyle guidance prior to the referral and the patients are now told they will be referred to structured education as a national requirement to help support them with self-managing their diabetes. Additionally, the lifestyle guidance provided by practices will ensure the appropriate uptake (attendance) at the S.E sessions.


Warrington CCG have performed better than Halton CCG in the last two years, where proportionally more carers in Warrington report that they feel supported the proportion in Halton has fallen and is now below the National average. Despite Halton being below the national average they are in the middle of their peer group, Warrington are top quartile.

DIABETES TREATMENT : 103A

DIABETES - STRUCTURED EDUCATION: 103B

SUPPORTED CARERS: 108A



39.1%

37.6%

39.8%

37.7%

37.8%

ENGLAND

2015-16

2016-17

2017-18

2018-19

38.7%

40.6%

41.0%

39.4%

41.7%

ENGLAND

2015-16

2016-17

2017-18

2018-19

12.1%

3.4%

0.8%

0.8%

11.7%

ENGLAND

2015-16

2016-17

2017-18…

2017/18…

12.1%

0.8%

0.6%

2.2%

1.6%

ENGLAND

2015-16

2016-17

2017-18…

2017/18…


57.3%

57.7%

55.6%

ENGLAND

2018

2019

57.3%

59.2%

59.6%

ENGLAND

2018

2019

TARGET

6%

ENG AVE

34.2%

ENG AVE

2060

19/20 Q2 15.07% 9.32%

2015/16 - 17/18 38.35% 31.80%

19/20 Q2 2881 2872




The Percentage of Women who were smokers at the time of delivery, out of the number of maternities .

Number of children in year 6 (aged 10 or 11) classified as overweight or obese in the National Child Measurement Programme (NCMP)

Age standardised rate of emergency hospital admissions for injuries due to falls for persons aged 65+ per 100,000 population

PREVENTING ILL HEALTH


Whilst neither CCG is acheiving the national target it is encouraging to see that Warrington CCG performs better than the national average and is in the best quartile in its peer group. Halton CCG is in the interquartile range of its peer group and has seen year on year reductions.


Note: most recent data is for 2017/18. Warrington CCG performs exceptionally well with respect to the number of overweight or obese children, with the lowest rate in their peer group, a rate below the England average and growth either flat or a slower rate of growth than is seen nationally. Halton performs above the England average and the growth rate is higher than the rate seen nationally.


Note: although the data from 18/19Q2 to 19/20 Q2 appears to show a significant reduction this is a result in a change of how this metric is calculated. Both Warrington and Halton CCG's have admission rates for falls much higher than the England average and in the top quartile of their respective peer groups. Warrington CCG has the highest fall admission rate in their peer group.

MATERNAL SMOKING AT DELIVERY: 129D

OVERWEIGHT OR OBESE CHILDREN: 102A

INJURIES FROM FALLS: 104A

Trend

Trend

6.00%

10.40%

18.51%

16.32%

15.07%

Target

Eng Ave

17/18 Q2

18/19 Q2

19/20 Q2

6.00%

10.40%

9.07%

9.75%

9.32%

Target

Eng Ave

17/18 Q2

18/19 Q2

19/20 Q2

0%

5%

10%

15%

20%

25%

Halton Warrington

England Target

Halton Warrington Benchmark

34.20%

36.06%

37.61%

38.35%

Eng Ave

2013/14 - 15/16

2014/15 - 16/17

2015/16 - 17/18

34.20%

31.46%

31.18%

31.80%

Eng Ave

2013/14 - 15/16

2014/15 - 16/17

2015/16 - 17/18

20%

25%

30%

35%

40%

Halton

Warrington

England Ave

Halton Warrington

2,060

3,026

4,326

2,881

Eng Ave

2017/18 Q2

2018/19 Q2

2019/20 Q2

2,060

2,973

3,784

2,872

Eng Ave

2017/18 Q2

2018/19 Q2

2019/20 Q2


TARGET

0.965

TARGET

10.0%

Nov-19 1.154 0.942

Nov-19 7.03% 7.15%




The number of antibiotics prescribed in primary care divided by the Item based Specific Therapeutic Age-Sex related Prescribing Unit STAR_PU .

The number of co-amoxiclav, cephalosporins and quinolones as a percentage of the total number of selected antibiotics prescribed in primary care

PREVENTING ILL HEALTH


Following two years of substantial reductions in prescribing rates the rate of reduction has plateaued, Warrington CCG has achieved the National standard and has the lowest prescribing rates in their peer group. Halton CCG has not achieved the standard and performs at the average rate for their peer group. Halton has a unusual situation in that all antibiotics prescribed in the UCC's are attributable to Halton CCG regardless of the CCG of the patient. Antibiotics prescribed in A&E are not attributable to a CCG.


Both CCG's perform significnatly below the national target.

APPROPRIATE PRESCRIBING OF ANTIBIOTICS IN PRIMARY CARE: 107a

BROAD SPECTRUM PRESCRIBING: 107B

Trend

Trend

0.800

1.000

1.200

1.400

HaltonWarringtonTarget

Halton Warrington

6%

8%

10%

12%

HaltonWarringtonTarget

Halton Warrington

0.965

1.275

1.230

1.154

Target

Nov-17

Nov-18

Nov-19

0.965

1.031

0.997

0.942

Target

Nov-17

Nov-18

Nov-19

10.00%

7.32%

7.18%

7.03%

Target

Nov-17

Nov-18

Nov-19

10.00%

7.75%

7.46%

7.15%

Target

Nov-17

Nov-18

Nov-19


2020/21 Financial Outlook NHS Halton CCG and NHS Warrington CCG Joint Governing Body Meeting 8th April 2020



DATE OF MEETING:

8th April 2020


Bryan Webb, Acting Chief Finance Officer

REPORT TITLE:

2020/21 Financial Outlook





X



X



Approval

✓

Assurance

✓

Discussion

Information

EXECUTIVE SUMMARY

The purpose of this paper is to provide an update to the Joint Governing Body of the financial outlook for both CCGs following the emergence of the national response, and associated guidance, for COVID-19.

RECOMMENDATIONS


• Note the revised financial outlook for each respective CCG; and



• Note that the CCGs await further guidance on the treatment of any deterioration from the Draft Financial Plan Submissions as a consequence of COVID-19.


Not Applicable


Not Applicable


NHS Halton CCG: BAF 36, 43, & 41 NHS Warrington CCG: B1 to B5


Yes

N/A


✓


✓


✓


✓



Not Applicable



Purpose

1. The purpose of this paper is to provide an update the Joint Governing Body of the financial outlook for both CCGs following the emergence of the national response, and associated guidance, to COVID-19.

2. Each CCG’s respective Governing Body has been presented with detail of the Draft Financial Plans during March 2020. Following the outbreak of the COVID-19 pandemic, the operational planning process has been paused and the assumptions included for 2020/21 have been replaced by national guidance, particularly aimed at providing financial security for NHS providers in this period of national response.

2020/21 Contractual Payments – NHS Providers

3. With the emergence of the COVID-19 pandemic in the UK, the NHS was quick to issue guidance to inform a revised contractual payment basis for the 2020/21 financial year aligned to providing financial stability in the immediate term. Appendix 1 details the “Revised arrangements for NHS contracting and payment during the COVID-19 pandemic” that is used to inform the revised financial outlook.

2020/21 Financial Outlook – NHS Halton CCG and NHS Warrington CCG

4. The immediate impact of the guidance included in Appendix 1, is that payments to NHS contracted providers will be based on “block contractual” arrangements, defined nationally using 2019/20 reported income inflated by 2.803% for growth, with four payments being transacted in the first quarter of the financial year. Payments will then revert to the monthly amounts provided for during planning for the seven periods running to February 2021. It is assumed at present that there will be no contractual payment during March 2021.

5. Any adverse movement for providers, from the planning stage, under this arrangement will be chargeable to the centre as COVID related. For CCGs, guidance is awaited to determine whether adverse movements will be chargeable or allowable against the financial outlooks included during the planning phase (i.e. a movement in agreed control total).

6. Investment expectations aligned to the Operational Planning guidance, particularly for the Mental Health Investment Standard (MHIS), are expected to still be secure during 2020/21.

7. Efficiency expectations over the initial period of national response have been relaxed, especially for NHS providers, as it is acknowledged that the operational focus will be prioritised on COVID-19. However, where opportunities for delivering efficiencies present, excluded from the COVID-19 response, organisations are encouraged to maintain the pursuit.

8. The 2020/21 financial outlook for NHS Halton CCG and NHS Warrington CCG has been revised to that included within the table below.



9. The financial outlook for both CCGs, on the assumption that changes as a result of the COVID-19 response are not centrally funded, deteriorates from a planned deficit of £8.6m for NHS Halton CCG to £11.6m. The same assumptions result in a deterioration from a planned deficit of £13.9m for NHS Warrington CCG to £15.4m. Collectively, this equates to a deterioration of £4.4m for the locality.

Recommendations

10. The Joint Governing Body is asked to:

• Note the revised financial outlook for each respective CCG; and • Note that the CCGs await further guidance on the treatment of any deterioration

from the Draft 2020/21 Financial Plan Submissions.

2020/21 Financial Outlook

NHS Halton

CCG

£000's

NHS

Warrington

CCG

£000's Detail

CCG Forecast Outturn 2018/19 242,233 336,932 Month 9 forecast outturn

2019/20 Non-Recurrent Allocations -7,327 -6,341 Reconciles to 19/20 Nrec allocations (includes HCP passthrough funding)

Other Full Year Effects 9,423 9,914 Impact of NW Protocol for in-year changes to forecast (month 11)

Opening 2020/21 Plan 244,329 340,505 £9.6m Underlying Deficit HCCG / £8.3m Underlying Deficit WCCG

Gross Provider Efficiency - (1.10%) -2,610 -3,371 National efficiency requirement

Gross Provider Inflation - 2.50% 6,184 8,765 National inflation requirement

Activity Growth – Demographic & Non Demographic 2,994 7,139 Activity Growth (Demographic & Non-Demographic)

Contingency - 0.50% 1,216 1,726 Minimum

GP Prescribing - Horizon Scanning 358 930 Meds Management

MHIS 1,056 1,544 National Standard

Primary Care Delegated (matching 20/21 Allocation) 624 1,382 Match Delegated Budget

BCF Growth 649 890 National Agreed Contribution (5.3%) 2 Year Impact

Other Recurrent Items 222 1,341 Local discretionary investment

QIPP Gross Saving -4,396 -3,484 Approximately 3% of Amenable budgets

Sub Total 2020/21 Recurrent Position 250,626 357,367 £7.5m Recurrent Deficit HCCG / £12.4m Recurrent Deficit WCCG

STP (0.5%) Earmarked Resource 1,106 1,560 C&M HCP Topslice

Draft Financial Plan - Total Application of Funds 251,732 358,927 £8.6m Planned Deficit HCCG / £13.9m Planned Deficit WCCG

COVID Block Contract Payment Approach 2020/21 1,854 575 Net impact across all providers

QIPP Assumption Revision 1,099 871 Assumed Q1 deferred due to COVID response

Revised Financial Outlook 2020/21 254,685 360,373 £11.6m Deficit HCCG / £15.4m Deficit WCCG

Publications approval reference: 001559 Date: 26 March 2020

NHS England and NHS Improvement

Revised arrangements for NHS contracting and payment during the COVID-19 pandemic

Contents

Contents

Introduction............................................................................................................ 1

Contractual arrangements for 2020/21 with NHS trusts/NHS foundation trusts .... 1

Contractual arrangements for 2020/21 with non-NHS providers operating under the NHS Standard Contract ................................................................................... 3

Introduction

Following publication of the letter to NHS bodies from Sir Simon Stevens and

Amanda Pritchard on 17 March 2020), we are clarifying below the implications for

contracting between commissioners and a) NHS Trusts/NHS foundation trusts and

b) other non-NHS providers.

The principles of our approach are to

• provide certainty for all organisations providing NHS-funded services under

the NHS Standard Contract that they will continue to be paid for the period

April to July 2020; and

• minimise the burden of formal contract documentation and contract

management processes, so that staff can focus fully on the COVID-19

response.

Further guidance is likely to be issued over time on specific arrangements to be put

in place with providers of particular services. Commissioners and providers should

follow the principles of the guidance below but be prepared to react to additional

service-specific guidance as and when published.

Contractual arrangements for 2020/21 with NHS trusts/NHS fountempldation trusts

NHS commissioners and NHS Trusts/NHS Foundation Trusts are not required to

sign contracts between them for 2020/21 at this time. The nationally mandated terms

of the NHS Standard Contract for 2020/21 will apply for these relationships from 1

April 2020. Commissioners and Trusts must not vary from the national terms.

The national deadline of 27 March 2020 for contract signature, set out in the NHS

Operational Planning and Contracting Guidance 2020/21, no longer applies. The

subsequent national process for mediation and arbitration for unsigned contracts will

no longer apply.

Payment will be made on the block basis described in the Stevens/Pritchard letter for

each month from April to July 2020. The specific amounts payable for each

commissioner / Trust relationship for which direct payment continues to be required

are being notified by NHS England and NHS Improvement via Sharepoint and the

provider portal.

Payment in respect of all other CCG/Trust relationships for April to July 2020 will be

managed nationally, as set out in the guidance on block payments issued separately.

https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/urgent-next-steps-on-nhs-response-to-covid-19-letter-simon-stevens.pdf

https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/urgent-next-steps-on-nhs-response-to-covid-19-letter-simon-stevens.pdf

Contracting and payment guidance page 2

These block payments are deemed to include CQUIN. The operation of CQUIN (both

CCG and specialised) for Trusts will be suspended for the period from April to July

2020; providers need therefore not take action to implement CQUIN requirements,

nor carry out CQUIN audits or submit CQUIN performance data. (Commissioners

and Trusts should also take a pragmatic approach to agreement of the final payment

amounts for the 2019/20 CQUIN scheme, and this should be on the basis of all

currently available data. We will not be seeking the submission of 2019/20 quarter 4

data from providers via the national CQUIN data collection.)

Further guidance about payment and contracting beyond 31 July 2020 will be issued

in due course.

Where commissioners and trusts have already agreed a new contract and/or

financial deal for 2020/21, this should be set aside for the period April-July 2020.

Where a commissioner and a trust already have a multi-year contract in place,

extending into 2020/21, payment to that trust will nevertheless be made as described

above, rather than in accordance with the existing contract.

The following should be noted in relation to contract management arrangements.

• Trusts must comply in a timely, complete and accurate way with mandatory

data flows (‘sit-rep’ reports) in relation to COVID-19. They should also

comply with other national reporting requirements (covered by NHS Digital

Approved Collections and Information Standards) unless notified otherwise.

Further guidance may be produced in the future on which national reporting

requirements should be prioritised.

• The provisions of the Contract offer protection for providers from liability for

failure to meet their contractual obligations, where they are unable to do so

as a result of an event of force majeure and/or their response to an

emergency situation. Trusts must do all that they reasonably can to continue

to comply with the national service requirements stated in the Contract, but

commissioners must recognise that these may not always be achieved in full

during the COVID-19 outbreak.

• As set out in the Stevens/Pritchard letter, all contractual sanctions are

suspended until further notice; commissioners must now not withhold

funding from Trusts in relation to failure to achieve any of the national

standards in Schedules 4A and 4B or local standards in Schedule 4C, or

under the provisions in GC9 for remedial action plans, or under SC28 for

information breaches.


Normal contract management meetings and processes should, in general, be

suspended. Commissioners should focus on helping Trusts to prepare for and

respond to the emergency and relax local reporting requirements (unless required for

business-critical purposes such as drug commercial arrangements) and other local

contractual measures which may be burdensome for provider staff, such as activity

management, Prior Approval Schemes and audits. Commissioners must also waive

the requirements in General Condition 28 of the Contract which require formal

notification to be sent in relation to Events of Force Majeure.

In relation to payment for high-cost drugs and devices (HCDD):

• For CCGs, any HCDD payments will be included within the block payments

described above.

• For specialised services commissioned by NHS England, HCDD will also be

included within the initial block payments. Top up payments for material

overperformance will be made as required. Note that this is slightly different

to the arrangements set out in the Stevens/Pritchard letter.

NHS England and NHS Improvement will shortly publish the 2020/21 National Tariff

Payment System. However, as the block payment arrangements above involve a

departure from National Tariff prices and rules, commissioners will need to confirm

the payment approach using a simple template document (also published as

Appendix 1) and submit via [email protected].

Welsh commissioners which have material flows of patients to English trusts have

agreed in principle to follow the same block payment approach described above. Any

activity outside of these arrangements should be paid using the 2020/21 National

Tariff prices.

Contractual arrangements for 2020/21 with non-NHS providers operating under the NHS Standard Contract

NOTE: This guidance does not apply to the commissioning of primary care.

Independent sector (IS) acute hospitals

As set out in the Stevens / Pritchard letter, national arrangements have been agreed

to buy capacity and support from IS acute hospitals. These arrangements will be in

place from 23 March 2020 and will run for at least 14 weeks. Further details,

including the list of specific IS providers within scope, will be shared as soon as

possible.


For the duration of these national arrangements, payment to the relevant IS

providers will be made direct by NHS England and NHS Improvement. Other CCG or

NHS England contracts (and sub-contracts from NHS trusts and foundation trusts)

with these providers will be set aside for the period covered by the national

arrangements. At least one month’s notice will be given to terminate the national

arrangements and revert to “business as usual”.

In respect of IS acute hospitals covered by the national arrangements, the following

will apply.

• Where an IS acute hospital provider either a) holds an existing multi-year

contract with an NHS commissioner which does not expire at 31 March 2020

or b) has agreed a new 2020/21 contract with its NHS commissioners, then

that contract should be suspended for the period for which the national

arrangement is in force – and will then be re-activated on its conclusion, on

the resumption of “business as usual”.

• Where an IS acute hospital provider holds a contract with an NHS

commissioner which expires at 31 March 2020 but has not yet agreed a new

contract for 2020/21, there is no immediate requirement to put a new

contract in place – because the new national arrangements will apply. Once

notice has been given to terminate the national arrangements, the

commissioners and the provider may, if they choose, enter into a new written

contract to cover the remainder of 2020/21. Until and unless they do,

however, the default position will be as set out below.

– The provider will be able to continue to provide elective services – and be

paid for providing them – on the same broad basis as under its 2019/20

contract.

– The nationally-mandated terms of the 2020/21 NHS Standard Contract

will apply, and the relevant national prices will be those set out in the

2020/21 National Tariff Payment System.

– The locally-agreed content of the Particulars of the local 2019/20 contract

will continue to apply (such as Service Specifications and Expected

Annual Contract Value)

– The provider will be commissioned to provide the same range of services

commissioned under its 2019/20 contract (unless the commissioner has

made clear, in writing prior to March 2020, its intention no longer to

commission a specific service).


In this way, IS acute hospitals will be able to provide services under the national

arrangements for the duration of the COVID-19 emergency, with confidence that

they will be able to revert to normal contractual arrangements when “business as

usual” resumes.

Other non-NHS providers commissioned under the NHS Standard Contract

Outside acute hospitals, non-NHS providers provide a very wide range of different

services. Depending on the specific services they run, providers will be affected by

COVID-19 in different ways. Some will have an important, direct role to play in the

response; some may be asked to expand, or change the nature of, the services they

provide in order to support the response; and, with others, the services they provide

may need to scaled back or put on hold.

There is already national guidance covering how out-of-hospital services will need to

respond to the COVID-19 pandemic – on services supporting discharge from

hospital, for instance, and on community services more generally (for both, see

https://www.england.nhs.uk/coronavirus/). Commissioners should have regard to this

and further guidance which may be published relating to other sectors.

In this context – with providers which are not NHS bodies and services which are, in

general, not covered by national prices – it is important from a governance

perspective that written contracts for 2020/21 are agreed as soon as possible.

Commissioners will need to exercise local discretion in terms of precise contractual

arrangements, depending on the role an individual provider is likely to play in the

COVID-19 response. General guidance is set out below.

• Contracts must be in the form of the NHS Standard Contract 2020/21, but

they need not be complex; the shorter-form version of the Contract will often

be appropriate.

• Commissioners are not mandated to take a block payment approach for the

period of April to July 2020, fixing payment at historic 2019/20 levels – but

such an approach will be appropriate in some circumstances.

• Where a provider provides services that will be essential to the local COVID-

19 response (including but not limited to services designated as

Commissioner Requested Services), and/or where a provider’s staff may

readily be redeployed into other COVID-19 related activities, a block

payment approach protecting the provider’s historic level of income should

be adopted. This may include community nursing and therapy services,

intermediate care, end of life care, mental health inpatient services and

community teams, and patient transport services, for instance.


• In other instances – where providers provide elective services on an Any

Qualified Provider basis (for example, some diagnostic and treatment

services), where levels of activity are likely to reduce significantly during the

pandemic, and where there is little scope for the provider’s staff to be

redeployed – it will be more appropriate to retain an “activity x price” basis

for payment. In such instances, where the provider’s income from NHS

commissioners falls, it will have access to the wider financial protections

offered by the government for businesses and employers (see

https://www.gov.uk/government/publications/guidance-to-employers-and-

businesses-about-COVID-19/COVID-19-support-for-businesses).

• CCGs, with local authority partners, will need to consider carefully making

appropriate contractual arrangements with care homes. A mixed economy

approach may be appropriate – continuing to pay for existing NHS

Continuing Healthcare cases on the basis of a weekly rate, whilst also

purchasing additional bed capacity to support hospital discharge on a block

or similar basis.

• Contracts should cover core funding for the services commissioned; there

will be separate arrangements for providers to claim exceptional additional

costs reasonably incurred as a direct result of COVID-19 and the response

to it. Details will be published in due course; to access such funding and

avoid any unintended double-payment, providers will be required to adopt an

open-book accounting approach.

• Although contracts should be put in place in this way, it is essential that

contracting processes do not delay or impede the necessary response to

COVID-19 from being put in place.

Of the arrangements described above for contracts with Trusts, the following also

apply to non-NHS providers other than acute hospitals.

• CQUIN is also suspended for April to July 2020; commissioners should

make CQUIN payments at the full applicable rate during this period.

• The Stevens / Pritchard letter made clear that the block payments made to

Trusts for April to July 2020 would include the national uplift for inflation and

CNST, but not the 1.1% increased efficiency requirement. This also applies

for non-NHS providers for April to July 2020, except for those providers

operating under national prices under the 2020/21 National Tariff on an

“activity x price” basis; the national prices have both inflation and efficiency

built in.


• The arrangements above for the suspension of contractual sanctions also

apply for the period April to July 2020, as does the light-touch approach to

contract management.

These arrangements will be reviewed before the end of July and will be extended as

necessary; further guidance relating to the period beyond 31 July 2020 will be issued

in due course.

Where monthly payments are being made in advance to non-NHS providers, based

on an Expected Annual Contract Value, commissioners should consider whether

they can bring forward payment timescales to align with the revised earlier

timescales for Trusts set out in separate guidance.

Where block payment is not agreed, commissioners and providers must be prepared

to show flexibility in relation to the strict application of the normal monthly timescales

in the contract for invoice validation and payment. And it is essential that

commissioners prioritise making agreed payments promptly to non-NHS providers,

to protect their cashflow.

Normal arrangements for invoicing and payment will continue to apply to any non-

contract activity carried out by non-NHS providers, but – given that most of this

relates to routine elective activity – levels during the period April to July 2020 are

expected to be minimal.

agenda body meeting... · 2020-04-08 · nhs halton ccg & nhs warrington ccg joint meeting of...

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